Provider Demographics
NPI:1972309664
Name:BROWN, EBONY CRYSTAL
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:CRYSTAL
Last Name:BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11410 NE 122ND WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6927
Mailing Address - Country:US
Mailing Address - Phone:425-650-4005
Mailing Address - Fax:
Practice Address - Street 1:11410 NE 122ND WAY STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6927
Practice Address - Country:US
Practice Address - Phone:425-650-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor