Healthcare Provider Details

I. General information

NPI: 1689597825
Provider Name (Legal Business Name): TERRELL BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDDIE TERRELL

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 OLD JACKSBORO HWY STE 200
WICHITA FALLS TX
76302-2700
US

IV. Provider business mailing address

PO BOX 41012
LUBBOCK TX
79409-1012
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-5281
  • Fax: 940-322-6743
Mailing address:
  • Phone: 806-742-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: