Healthcare Provider Details

I. General information

NPI: 1053818294
Provider Name (Legal Business Name): JUSTIN BROWN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AIRPORT RD
TERRELL TX
75160-4302
US

IV. Provider business mailing address

PO BOX 747
TERRELL TX
75160-0014
US

V. Phone/Fax

Practice location:
  • Phone: 972-524-4159
  • Fax: 972-524-1002
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65283
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: