MEDICARE: TERRY DALE BROWN JR. 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	103TC0700X	Clinical Psychologist	1120	KS

General Provider Information

NPI Number	:	1649464157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY DALE BROWN JR. PH.D.

Provider Business Mailing Address
First Line	:	2020 S MEMORIAL DR
Second Line	:	SUITE 1
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-1272
Country	:	US
Telephone Number	:	765-465-3387
Fax Number	:	888-441-0851

Provider Business Practice Location Address
First Line	:	2020 S MEMORIAL DR
Second Line	:	SUITE 1
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-1272
Country	:	US
Telephone Number	:	765-465-3387
Fax Number	:	888-441-0851

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	10/20/2015

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