Healthcare Provider Details

I. General information

NPI: 1376437814
Provider Name (Legal Business Name): JILL ELAINE BROWN LPC-ASSOCIATE, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WATERS EDGE DR STE 120
GRANBURY TX
76048-1474
US

IV. Provider business mailing address

3207 GOLDEN OAKS CIR
GRANBURY TX
76049-2982
US

V. Phone/Fax

Practice location:
  • Phone: 817-290-5996
  • Fax:
Mailing address:
  • Phone: 817-219-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15122
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number98861
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: