Provider Demographics
NPI:1861639940
Name:BROWN, PHILIP W (PHD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:W
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:P.O. BOX 387
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0387
Mailing Address - Country:US
Mailing Address - Phone:870-424-4804
Mailing Address - Fax:870-424-4804
Practice Address - Street 1:204 NORTH COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3654
Practice Address - Country:US
Practice Address - Phone:870-424-4804
Practice Address - Fax:870-424-8651
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9812P103T00000X
AR98-12P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V700Medicare PIN