Provider Demographics
NPI:1396905964
Name:BROWN, MICHAEL (MFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15495 LOS GATOS BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2544
Mailing Address - Country:US
Mailing Address - Phone:408-981-4224
Mailing Address - Fax:408-884-9705
Practice Address - Street 1:15495 LOS GATOS BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2544
Practice Address - Country:US
Practice Address - Phone:408-981-4224
Practice Address - Fax:408-884-9705
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist