=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831588557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEQUOIA BROWN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2015
-----------------------------------------------------
Last Update Date | 01/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 S COLLEGIATE DR
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-6309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-517-4063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1019 S COLLEGIATE DR
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-6309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-517-4063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | SEQUOIA BROWN
-----------------------------------------------------
Credential | M.S. LPC. LCDC
-----------------------------------------------------
Telephone | 903-517-4063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 5369
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 72961
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------