Provider Demographics
NPI:1639670896
Name:BROWN, KENNARD L
Entity Type:Individual
Prefix:
First Name:KENNARD
Middle Name:L
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 1:5135 CAMINO AL NORTE STE 267
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2419
Mailing Address - Country:US
Mailing Address - Phone:702-805-0254
Mailing Address - Fax:702-979-1352
Practice Address - Street 1:5135 CAMINO AL NORTE STE 267
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2419
Practice Address - Country:US
Practice Address - Phone:702-805-0254
Practice Address - Fax:702-979-1352
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health