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General NPI Number Information
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NPI Number | 1104156520
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Entity Type | Organization
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Legal Business Name | BROWN & ASSOCIATES OF WINDSOR, LLC
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 104 N MAIN ST
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City | WINDSOR
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State | MO
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Zip | 65360-1355
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Country | US
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Telephone | 660-647-0144
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Fax | 660-647-0145
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Provider Business Mailing Address
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Address Line | 104 N MAIN ST
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City | WINDSOR
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State | MO
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Zip | 65360-1355
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Country | US
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Telephone | 660-647-0144
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Fax | 660-647-0145
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Authorized Official
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Title or Position | OWNER
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Name | LISA BROWN
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Credential | PSYD
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Telephone | 660-647-0144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2004033891
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License Number State | MO
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