MEDICARE: KRISTINA KAY BROWN LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	78965	TX
2	101YP2500X	Professional Counselor	78965	TX
3	101YM0800X	Mental Health Counselor	78965	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78965	OTHER	TX	LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1548998982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA KAY BROWN LPC

Provider Business Mailing Address
First Line	:	125 CHICAGO AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-1605
Country	:	US
Telephone Number	:	806-549-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 CHICAGO AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-1605
Country	:	US
Telephone Number	:	806-549-1169
Fax Number	:

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	08/12/2022

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