Healthcare Provider Details

I. General information

NPI: 1578885927
Provider Name (Legal Business Name): CYNTHIA DENISE BROWN LCDC, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ROARING SPRINGS DR
GLENN HEIGHTS TX
75154-7925
US

IV. Provider business mailing address

3501 E GORE BLVD APT 1118
LAWTON OK
73501-6859
US

V. Phone/Fax

Practice location:
  • Phone: 214-604-2392
  • Fax:
Mailing address:
  • Phone: 214-604-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8271
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number52633
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: