Healthcare Provider Details

I. General information

NPI: 1548156961
Provider Name (Legal Business Name): SHANNON BROWN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGXW 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

60 MDG/SGXW 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: