Provider Demographics
NPI:1033402797
Name:BROWN, SHELVY SR (BS, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELVY
Middle Name:
Last Name:BROWN
Suffix:SR
Gender:M
Credentials:BS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 TOEPPERWEIN RD STE 212B
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3250
Mailing Address - Country:US
Mailing Address - Phone:636-541-3807
Mailing Address - Fax:
Practice Address - Street 1:12702 TOEPPERWEIN RD STE 212B
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3250
Practice Address - Country:US
Practice Address - Phone:636-541-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260192225800000X
CA10072014101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist