Provider Demographics
NPI:1386114064
Name:BROWER, MICHAEL R (PSYD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:BROWER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 N SWAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5445
Mailing Address - Country:US
Mailing Address - Phone:520-954-9930
Mailing Address - Fax:520-342-0136
Practice Address - Street 1:5501 N SWAN RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5445
Practice Address - Country:US
Practice Address - Phone:520-954-9930
Practice Address - Fax:520-342-0136
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005047103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty