Provider Demographics
NPI:1891115523
Name:BROWN, TERRY D
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ND
Mailing Address - Zip Code:58054-0628
Mailing Address - Country:US
Mailing Address - Phone:701-683-6135
Mailing Address - Fax:701-683-4491
Practice Address - Street 1:205 4TH AVE W
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054-4109
Practice Address - Country:US
Practice Address - Phone:701-683-6135
Practice Address - Fax:701-683-4491
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1024104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker