Provider Demographics
NPI:1689004343
Name:BROWN, COREY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
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 1:1896 E 167TH DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7683
Mailing Address - Country:US
Mailing Address - Phone:303-870-0995
Mailing Address - Fax:
Practice Address - Street 1:2600 S GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5708
Practice Address - Country:US
Practice Address - Phone:303-733-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-17
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness