Provider Demographics
NPI:1205101508
Name:BROWN, STEPHEN MARK (LPC 1773)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPC 1773
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2960
Mailing Address - Country:US
Mailing Address - Phone:307-439-4928
Mailing Address - Fax:
Practice Address - Street 1:1432 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2960
Practice Address - Country:US
Practice Address - Phone:307-439-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCAP-123101YA0400X
WY1773101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional