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General NPI Number Information
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NPI Number | 1487063913
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Entity Type | Individual
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Provider Name | SHAMAYNE MARIAH BROWN PHD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 275 SOUTH ASPEN ST STOP 89
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City | BUCKLEY SFB
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State | CO
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Zip | 80011
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 275 SOUTH ASPEN ST, STOP 89 460 MDG
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City | BUCKLEY SFB
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State | CO
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Zip | 80011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60934631
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY00005856
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License Number State | CO
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