Provider Demographics
NPI:1912390204
Name:BROWN, CALVIN D JR
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:D
Last Name:BROWN
Suffix:JR
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 1:9999 W KATIE AVE UNIT 1208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8367
Mailing Address - Country:US
Mailing Address - Phone:702-205-0048
Mailing Address - Fax:
Practice Address - Street 1:9999 W KATIE AVE UNIT 1208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8367
Practice Address - Country:US
Practice Address - Phone:702-205-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health