Provider Demographics
NPI:1497531016
Name:BROWN, GARRY HENRY (DTH)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:HENRY
Last Name:BROWN
Suffix:
Gender:M
Credentials:DTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 MITCHELL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2156
Mailing Address - Country:US
Mailing Address - Phone:209-388-3027
Mailing Address - Fax:209-416-4110
Practice Address - Street 1:1768 MITCHELL RD STE 301
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2156
Practice Address - Country:US
Practice Address - Phone:209-388-3027
Practice Address - Fax:209-416-4110
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)