Provider Demographics
NPI:1902447162
Name:BROWN, CHRISTOPHER NATHAN (MS ED BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:NATHAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MS ED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 DONA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3626
Mailing Address - Country:US
Mailing Address - Phone:850-830-2766
Mailing Address - Fax:
Practice Address - Street 1:124 E MIRACLE STRIP PKWY STE 503
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1991
Practice Address - Country:US
Practice Address - Phone:850-301-0438
Practice Address - Fax:844-308-4990
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-38286103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst