Provider Demographics
NPI:1396178232
Name:BROWN, PATRIS A (CADC-CAS)
Entity Type:Individual
Prefix:MRS
First Name:PATRIS
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:PATRIS
Other - Middle Name:A
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1221 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3107
Mailing Address - Country:US
Mailing Address - Phone:310-906-8428
Mailing Address - Fax:
Practice Address - Street 1:1221 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3107
Practice Address - Country:US
Practice Address - Phone:310-906-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CAC040531216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner