Healthcare Provider Details

I. General information

NPI: 1437364247
Provider Name (Legal Business Name): MARY EVELYN BROWN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 CRANE RIDGE DR SUITE 101
JACKSON MS
39216-4912
US

IV. Provider business mailing address

1818 CRANE RIDGE DR SUITE 101
JACKSON MS
39216-4912
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-1008
  • Fax: 601-982-9090
Mailing address:
  • Phone: 601-981-1008
  • Fax: 601-982-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number160
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: