Provider Demographics
NPI:1174709752
Name:BROWN, STEVE LAMAR (LISAC)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:LAMAR
Last Name:BROWN
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3820
Mailing Address - Country:US
Mailing Address - Phone:866-207-3882
Mailing Address - Fax:
Practice Address - Street 1:10240 N 31ST AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9565
Practice Address - Country:US
Practice Address - Phone:602-997-9006
Practice Address - Fax:602-395-1764
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-109121835G0303X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric