Provider Demographics
NPI:1326587981
Name:BROWN, ALYSIA
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74957-5008
Mailing Address - Country:US
Mailing Address - Phone:580-306-3601
Mailing Address - Fax:
Practice Address - Street 1:6033 LOOP RD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:OK
Practice Address - Zip Code:74957-5008
Practice Address - Country:US
Practice Address - Phone:580-306-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health