Provider Demographics
NPI:1144217290
Name:BROWN, JAMES J (LCSW LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2428
Mailing Address - Country:US
Mailing Address - Phone:903-586-6736
Mailing Address - Fax:903-586-2412
Practice Address - Street 1:703 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2428
Practice Address - Country:US
Practice Address - Phone:903-586-6736
Practice Address - Fax:903-586-2412
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCSW00357101YM0800X
TXLPC004887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095305101Medicaid
TX095305103Medicaid
TX095305104Medicaid
TX095305103Medicaid