Provider Demographics
NPI:1750045415
Name:BROWN, JOHN THOMAS RYAN (LSCW)
Entity Type:Individual
Prefix:
First Name:JOHN THOMAS
Middle Name:RYAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N RANDOLPH ST STE 231
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3949
Mailing Address - Country:US
Mailing Address - Phone:217-689-1700
Mailing Address - Fax:
Practice Address - Street 1:206 N RANDOLPH ST STE 231
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3949
Practice Address - Country:US
Practice Address - Phone:217-689-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
149.0134301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical