Healthcare Provider Details

I. General information

NPI: 1497890776
Provider Name (Legal Business Name): TERRI N BROWN LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 50TH ST STE 100
LUBBOCK TX
79412-2566
US

IV. Provider business mailing address

6011 72ND ST
LUBBOCK TX
79424-1903
US

V. Phone/Fax

Practice location:
  • Phone: 806-780-8300
  • Fax: 806-780-8383
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8561
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: