Provider Demographics
NPI:1275539553
Name:BROWN, KAYLENE (LPC)
Entity Type:Individual
Prefix:
First Name:KAYLENE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N KLINE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4084
Mailing Address - Country:US
Mailing Address - Phone:806-785-2330
Mailing Address - Fax:806-785-2330
Practice Address - Street 1:5121 69TH ST # B702
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1645
Practice Address - Country:US
Practice Address - Phone:806-239-2638
Practice Address - Fax:806-785-2330
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164817201Medicaid