Provider Demographics
NPI:1275382822
Name:BROWN, ANTWAUN MARICE
Entity type:Individual
Prefix:
First Name:ANTWAUN
Middle Name:MARICE
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 BELMONT CANYON PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6174
Mailing Address - Country:US
Mailing Address - Phone:702-722-7864
Mailing Address - Fax:
Practice Address - Street 1:157 BELMONT CANYON PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6174
Practice Address - Country:US
Practice Address - Phone:702-722-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty