Provider Demographics
NPI:1679659643
Name:BRAWNER, ERNEST L (LCSW CAS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:L
Last Name:BRAWNER
Suffix:
Gender:M
Credentials:LCSW CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 CRESCENT VALLEY COURT
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088
Mailing Address - Country:US
Mailing Address - Phone:314-434-6009
Mailing Address - Fax:636-946-2980
Practice Address - Street 1:777 CRAIG RD
Practice Address - Street 2:STE 130
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-434-6009
Practice Address - Fax:636-946-2980
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW003721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124868OtherBCBS
MO124868OtherBCBS