Provider Demographics
NPI:1013168970
Name:BROWN, KEVIN G SR
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:G
Last Name:BROWN
Suffix:SR
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 1:81840 AVENUE 46
Mailing Address - Street 2:201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3936
Mailing Address - Country:US
Mailing Address - Phone:760-391-6999
Mailing Address - Fax:760-391-6998
Practice Address - Street 1:81840 AVENUE 46
Practice Address - Street 2:201
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3936
Practice Address - Country:US
Practice Address - Phone:760-391-6999
Practice Address - Fax:760-391-6998
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health