Provider Demographics
NPI:1164421350
Name:BROWN, RAY H (PHD, PC)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:H
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 58TH ST
Mailing Address - Street 2:#600
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-2000
Mailing Address - Country:US
Mailing Address - Phone:806-792-3808
Mailing Address - Fax:806-792-1506
Practice Address - Street 1:5502 58TH ST
Practice Address - Street 2:#600
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-2000
Practice Address - Country:US
Practice Address - Phone:806-792-3808
Practice Address - Fax:806-792-1506
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136097100OtherCOMPCARE
TX0338899-01Medicaid
TXHM75OtherBC/BS
TX0338899-01Medicaid