MEDICARE: AMY G BROWN LP, LSSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	36123	TX
2	103TC2200X	Clinical Child & Adolescent Psychologist	36123	TX
3	103TC0700X	Clinical Psychologist	36123	TX

General Provider Information

NPI Number	:	1013256312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY G BROWN LP, LSSP

Provider Business Mailing Address
First Line	:	13785 RESEARCH BLVD
Second Line	:	125
City	:	AUSTIN
State	:	TX
Zip	:	78750-1873
Country	:	US
Telephone Number	:	512-238-3042
Fax Number	:	512-655-2101

Provider Business Practice Location Address
First Line	:	13785 RESEARCH BLVD
Second Line	:	SUITE 125
City	:	AUSTIN
State	:	TX
Zip	:	78750-1873
Country	:	US
Telephone Number	:	512-238-3042
Fax Number	:	512-655-2101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	01/24/2018

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