Provider Demographics
NPI:1689190654
Name:BROWN, EARL JR (BS,MPA)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:BS,MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 LANTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-3854
Mailing Address - Country:US
Mailing Address - Phone:417-256-2570
Mailing Address - Fax:
Practice Address - Street 1:12 OSAGE PATH
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:417-274-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MO10269101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)