Provider Demographics
NPI:1104586106
Name:BROWNE, KENNETH (LPC IT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:BROWNE
Suffix:
Gender:M
Credentials:LPC IT
Other - Prefix:MR
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8605 N GREENVALE RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2435
Mailing Address - Country:US
Mailing Address - Phone:414-458-1678
Mailing Address - Fax:
Practice Address - Street 1:6815 W CAPITOL DR STE 208
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2056
Practice Address - Country:US
Practice Address - Phone:414-466-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19332-130101YA0400X
WI5157-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)