Provider Demographics
NPI:1093530768
Name:BROWN, COURTNEY B
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MAILE ST APT A14
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4338
Mailing Address - Country:US
Mailing Address - Phone:347-622-1258
Mailing Address - Fax:
Practice Address - Street 1:50 MAILE ST APT A14
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4338
Practice Address - Country:US
Practice Address - Phone:347-622-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician