Provider Demographics
NPI:1154568871
Name:BROWN, NICHOLAS DAVID (MA LMHC)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:DAVID
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 CERRILLOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3373
Mailing Address - Country:US
Mailing Address - Phone:505-438-0010
Mailing Address - Fax:
Practice Address - Street 1:2900 PUEBLO ALTO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2519
Practice Address - Country:US
Practice Address - Phone:505-999-0203
Practice Address - Fax:505-792-7984
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0112861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02097780008Medicaid