Provider Demographics
NPI:1356926471
Name:BROWN & BROWN CONSULTATION CENTER LLC
Entity type:Organization
Organization Name:BROWN & BROWN CONSULTATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITONER
Authorized Official - Phone:313-247-4020
Mailing Address - Street 1:24438 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1888
Mailing Address - Country:US
Mailing Address - Phone:248-252-9730
Mailing Address - Fax:
Practice Address - Street 1:24438 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-1888
Practice Address - Country:US
Practice Address - Phone:248-252-9730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty