Healthcare Provider Details

I. General information

NPI: 1538916473
Provider Name (Legal Business Name): SHELBY BROWN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 HIGHWAY 7E E
NACOGDOCHES TX
75961-8918
US

IV. Provider business mailing address

1531 E AUSTIN ST
NACOGDOCHES TX
75965-2931
US

V. Phone/Fax

Practice location:
  • Phone: 936-615-7927
  • Fax:
Mailing address:
  • Phone: 662-316-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number87099
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: