Healthcare Provider Details

I. General information

NPI: 1255254595
Provider Name (Legal Business Name): AUTUMN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 COUNTY ROAD 4929
NEWARK TX
76071-3139
US

IV. Provider business mailing address

543 COUNTY ROAD 4929
NEWARK TX
76071-3139
US

V. Phone/Fax

Practice location:
  • Phone: 940-783-8829
  • Fax:
Mailing address:
  • Phone: 940-783-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: