Individual
BRADLEY THOMAS BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Mailing address
1612 1ST ST E, WEST FARGO, ND 58078-4271
(701) 793-2736
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1332
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21466
BCBS
ND
01
—
412781020163
PREFERRED ONE
—
Enumeration date
09/28/2006
Last updated
10/23/2014
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