Basic Information
| Provider Information | |||||||||
| NPI: | 1811900905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC MHSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1167 SPRATLIN PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376156205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234673600 | ||||||||
| FaxNumber: | 4234673644 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 HOLSTON DR | ||||||||
| Address2: | NOLACHUCKEY MENTAL HEALTH CENTER FRONTIER HEALTH | ||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236391104 | ||||||||
| FaxNumber: | 4236368365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 10/14/2019 | ||||||||
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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 | 101Y00000X | LPC1533 | TN | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 1533 | TN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 4098479 | 01 | MAGELLAN PINNACLE | OTHER | 620582605 | 01 | CARITEN PHP POS | OTHER | 620582605 | 01 | CARITEN PHP HMO | OTHER | 620582605 021 | 01 | TRICARE SOUTH | OTHER | 620582605 | 01 | CARITEN PHP PPO | OTHER | 334969 | 01 | VALUE OPTIONS GROUP | OTHER | 4098479 | 01 | MAGELLAN SUMMIT | OTHER | 620582605 | 01 | CARITEN SENIOR PPO | OTHER | 620582605 | 01 | MENTAL HEALTH NETW | OTHER | 4098479 | 01 | MAGELLAN NAVIGATOR | OTHER | 620582605 | 01 | PHCS | OTHER | 620582605 | 01 | INITIAL GROUP | OTHER | 620582605 | 01 | CARITEN SENIOR HMO | OTHER | 620582605 | 01 | CORPHEALTH | OTHER | 351654200 | 01 | DOL WORKERS COMP | OTHER | 290298 | 01 | MANAGED HEALTH NET | OTHER | 620582605 | 01 | THREE RIVERS PROVI GROUP | OTHER | 620582605 | 01 | CAR PHP MEDICARE H | OTHER | 620582605 | 01 | CAR PHP LEASE PPO | OTHER | 620582605 | 01 | CARITEN PHP WORKCO | OTHER |