Provider Demographics
NPI:1326117227
Name:BROWN, THOMAS GERALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERALD
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 ARNOLD DR # C3
Mailing Address - Street 2:
Mailing Address - City:LR AFB
Mailing Address - State:AR
Mailing Address - Zip Code:72099-4933
Mailing Address - Country:US
Mailing Address - Phone:501-987-7338
Mailing Address - Fax:501-987-8087
Practice Address - Street 1:1090 ARNOLD DR # C3
Practice Address - Street 2:
Practice Address - City:LR AFB
Practice Address - State:AR
Practice Address - Zip Code:72099-4933
Practice Address - Country:US
Practice Address - Phone:501-987-7338
Practice Address - Fax:501-987-8087
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0631P103TC0700X
AR06-31P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical