Provider Demographics
NPI:1629378278
Name:BROWN, KEVIN ELIOT (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ELIOT
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 S RIVER AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3253
Mailing Address - Country:US
Mailing Address - Phone:616-283-2872
Mailing Address - Fax:
Practice Address - Street 1:246 S RIVER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3253
Practice Address - Country:US
Practice Address - Phone:616-283-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003867103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist