Provider Demographics
NPI:1821547597
Name:M STEPHEN BROWN
Entity Type:Organization
Organization Name:M STEPHEN BROWN
Other - Org Name:MARK BROWN
Other - Org Type:Other Name
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-317-5479
Mailing Address - Street 1:1901 MAIN AVE SUITE 101
Mailing Address - Street 2:10 TOWN PLAZ 331
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-317-5479
Mailing Address - Fax:
Practice Address - Street 1:10 TOWN PLZ
Practice Address - Street 2:331
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5104
Practice Address - Country:US
Practice Address - Phone:970-317-5479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0003417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO101YP2500XMedicaid
CO101YP2500XMedicare PIN