Provider Demographics
NPI:1730654401
Name:BROWN, NICHOLAS (PHD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 BROADWAY STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2066
Mailing Address - Country:US
Mailing Address - Phone:213-290-0146
Mailing Address - Fax:
Practice Address - Street 1:8301 BROADWAY STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2066
Practice Address - Country:US
Practice Address - Phone:213-290-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30387103TC0700X
TX39919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical