Provider Demographics
NPI:1659117422
Name:BROWN, NICOLAS R (LMFTA)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N 73RD ST APT 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5348
Mailing Address - Country:US
Mailing Address - Phone:206-579-7200
Mailing Address - Fax:
Practice Address - Street 1:4010 STONE WAY N STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8099
Practice Address - Country:US
Practice Address - Phone:206-579-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61519939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health