Healthcare Provider Details

I. General information

NPI: 1871542381
Provider Name (Legal Business Name): IRIS LYNNE BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 MEDICAL CENTER PKWY
SELMA AL
36701-6780
US

IV. Provider business mailing address

2007 3RD AVENUE CIR
SELMA AL
36701
US

V. Phone/Fax

Practice location:
  • Phone: 334-875-2100
  • Fax: 334-418-6540
Mailing address:
  • Phone: 334-875-2100
  • Fax: 334-418-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number948C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: