Provider Demographics
NPI:1588175012
Name:M BROWN RECOVERY
Entity type:Organization
Organization Name:M BROWN RECOVERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:FROMM
Authorized Official - Suffix:
Authorized Official - Credentials:CDP, BS
Authorized Official - Phone:425-347-9070
Mailing Address - Street 1:7207 EVERGREEN WAY STE M
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-5678
Mailing Address - Country:US
Mailing Address - Phone:425-347-9070
Mailing Address - Fax:425-348-3676
Practice Address - Street 1:7207 EVERGREEN WAY STE M
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-5678
Practice Address - Country:US
Practice Address - Phone:425-347-9070
Practice Address - Fax:425-348-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QR0405X
WA037600324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder