Provider Demographics
NPI:1629413638
Name:BROWN, ANGEL C (MS CLINICAL HEALTH)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS CLINICAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9764 CORNWALL CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6743
Mailing Address - Country:US
Mailing Address - Phone:856-340-3849
Mailing Address - Fax:
Practice Address - Street 1:4425 S JONES BLVD # D3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3370
Practice Address - Country:US
Practice Address - Phone:702-991-3150
Practice Address - Fax:866-658-4052
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV104100000X101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health