MEDICARE: STELLA W. BROWN PH.D.

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	103TC1900X	Counseling Psychologist	35-571	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144233750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA W. BROWN PH.D.

Provider Business Mailing Address
First Line	:	2614 SOUTHERLAND ST
Second Line	:	SUITE ONE
City	:	JACKSON
State	:	MS
Zip	:	39216-4858
Country	:	US
Telephone Number	:	601-362-2624
Fax Number	:	601-362-2622

Provider Business Practice Location Address
First Line	:	2614 SOUTHERLAND ST
Second Line	:	SUITE ONE
City	:	JACKSON
State	:	MS
Zip	:	39216-4858
Country	:	US
Telephone Number	:	601-362-2624
Fax Number	:	601-362-2622

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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