Provider Demographics
NPI:1760961551
Name:BROWN, ROBERT GENE (LLPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GENE
Last Name:BROWN
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 43RD ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-3036
Mailing Address - Country:US
Mailing Address - Phone:616-460-4824
Mailing Address - Fax:
Practice Address - Street 1:251 43RD ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-3036
Practice Address - Country:US
Practice Address - Phone:616-460-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015724101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional