Provider Demographics
NPI:1508631953
Name:BROWN, ERIC WILLIAM
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10745 48TH AVE UNIT U1
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8126
Mailing Address - Country:US
Mailing Address - Phone:810-404-7714
Mailing Address - Fax:
Practice Address - Street 1:10745 48TH AVE UNIT U1
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8126
Practice Address - Country:US
Practice Address - Phone:810-404-7714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician