MEDICARE: CARISSA BROWN MA, LPC ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	94931	TX

General Provider Information

NPI Number	:	1295383081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA BROWN MA, LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	2300 MARSH LN
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-4851
Country	:	US
Telephone Number	:	469-702-1387
Fax Number	:

Provider Business Practice Location Address
First Line	:	13355 NOEL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6602
Country	:	US
Telephone Number	:	469-702-1387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	05/29/2024

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