MEDICARE: MRS. MARY ANN BROWN

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	101YP2500X	Professional Counselor	9135	TX
2	103T00000X	Psychologist	012406	TX
3	103T00000X	Psychologist	09135	TX
4	1041C0700X	Clinical Social Worker	120406	TX
5	1041C0700X	Clinical Social Worker	12406	TX

General Provider Information

NPI Number	:	1023187861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANN BROWN

Provider Business Mailing Address
First Line	:	PO BOX 178
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086
Country	:	US
Telephone Number	:	817-599-8040
Fax Number	:	817-596-0404

Provider Business Practice Location Address
First Line	:	1706 SANTA FE DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-6420
Country	:	US
Telephone Number	:	817-599-8040
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	06/15/2022

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