Healthcare Provider Details

I. General information

NPI: 1225716632
Provider Name (Legal Business Name): MAGEN DAWN BROWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 KEMP BLVD
WICHITA FALLS TX
76308-1017
US

IV. Provider business mailing address

2934 KEMP BLVD
WICHITA FALLS TX
76308-1017
US

V. Phone/Fax

Practice location:
  • Phone: 940-228-6644
  • Fax:
Mailing address:
  • Phone: 940-228-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number90417
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: