Provider Demographics
NPI:1861129405
Name:BROWN, NATHANIEL ODELL (PHD, CSWA)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:ODELL
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14372 TALAWA DR
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7143
Mailing Address - Country:US
Mailing Address - Phone:503-404-3637
Mailing Address - Fax:
Practice Address - Street 1:14372 TALAWA DR
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-7143
Practice Address - Country:US
Practice Address - Phone:503-404-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA56941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical