Healthcare Provider Details

I. General information

NPI: 1144233750
Provider Name (Legal Business Name): STELLA W. BROWN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 SOUTHERLAND ST SUITE ONE
JACKSON MS
39216-4858
US

IV. Provider business mailing address

2614 SOUTHERLAND ST SUITE ONE
JACKSON MS
39216-4858
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-2624
  • Fax: 601-362-2622
Mailing address:
  • Phone: 601-362-2624
  • Fax: 601-362-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35-571
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: