Healthcare Provider Details

I. General information

NPI: 1962307975
Provider Name (Legal Business Name): BROWN BEHAVIORAL HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 S 40TH AVE
HATTIESBURG MS
39402-2915
US

IV. Provider business mailing address

2203 S 40TH AVE
HATTIESBURG MS
39402-2915
US

V. Phone/Fax

Practice location:
  • Phone: 601-818-6339
  • Fax:
Mailing address:
  • Phone: 601-818-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA QUIN BROWN
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 601-818-6339