Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH12133 | FL |
N | 101YS0200X | School Counselor | 1033055 | FL |
NPI | 1174785067 |
---|---|
Provider Name | Mr. Homer Roosevelt Brown |
First Address | Rockledge, FL 32955-2333 |
Second Address | Rockledge, FL 32955-2333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 16/11/2013 |