Provider Demographics
NPI:1295283406
Name:BROWN, MARK STEPHEN (LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:M
Other - Middle Name:STEPHEN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1911 MAIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5078
Mailing Address - Country:US
Mailing Address - Phone:970-317-5479
Mailing Address - Fax:
Practice Address - Street 1:10 TOWN PLZ
Practice Address - Street 2:331
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5104
Practice Address - Country:US
Practice Address - Phone:970-317-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0003417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional