Provider Demographics
NPI:1437364247
Name:BROWN, MARY EVELYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:EVELYN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1818 CRANE RIDGE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4912
Mailing Address - Country:US
Mailing Address - Phone:601-981-1008
Mailing Address - Fax:601-982-9090
Practice Address - Street 1:1818 CRANE RIDGE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4912
Practice Address - Country:US
Practice Address - Phone:601-981-1008
Practice Address - Fax:601-982-9090
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical