Provider Demographics
NPI:1508321886
Name:BROWN, TERRA BROWN
Entity Type:Individual
Prefix:MISS
First Name:TERRA
Middle Name:BROWN
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 1:5678 ALLEN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2611
Mailing Address - Country:US
Mailing Address - Phone:408-417-8455
Mailing Address - Fax:501-553-8550
Practice Address - Street 1:ONE EASTMONT MALL TOWN CENTER
Practice Address - Street 2:7200 BANCROFT AVENUE BUILDING B. SUITE 133
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605
Practice Address - Country:US
Practice Address - Phone:510-553-8500
Practice Address - Fax:510-553-8550
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health