Provider Demographics
NPI:1174157408
Name:BROWN, MICHAEL (BCBA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 N 700 E
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-8258
Mailing Address - Country:US
Mailing Address - Phone:661-221-2730
Mailing Address - Fax:
Practice Address - Street 1:727 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2449
Practice Address - Country:US
Practice Address - Phone:801-210-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst