Basic Information
| Provider Information | |||||||||
| NPI: | 1174660328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | NONE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 527 SW CHAPMAN ST | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973781604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712415625 | ||||||||
| FaxNumber: | 5033634820 | ||||||||
| Practice Location | |||||||||
| Address1: | 3325 HAROLD DR NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035405571 | ||||||||
| FaxNumber: | 5033634820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 08/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 07-P-09 | OR | Y | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | 07-P-09 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.