Provider Demographics
NPI:1104987460
Name:BROWN, WILLIAM C (LPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S 3RD PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2405
Mailing Address - Country:US
Mailing Address - Phone:425-228-0074
Mailing Address - Fax:425-226-2531
Practice Address - Street 1:175 WEST 1400 NORTH
Practice Address - Street 2:SUITE A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-2326
Practice Address - Country:US
Practice Address - Phone:435-752-5302
Practice Address - Fax:435-753-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT126068-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional