Provider Demographics
NPI:1538307418
Name:BROWN, JANICE V
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:V
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JANICE
Other - Middle Name:B
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:804 N PARKWAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3058
Mailing Address - Country:US
Mailing Address - Phone:731-423-3020
Mailing Address - Fax:731-927-8603
Practice Address - Street 1:804 N PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3058
Practice Address - Country:US
Practice Address - Phone:731-423-3020
Practice Address - Fax:731-927-8603
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1871676593OtherPRACTICE NPI NUMBER
TN4448133Medicaid
TN626000729OtherPRACTICE TAX ID NUMBER
TN626000729OtherPRACTICE TAX ID NUMBER
TN1871676593OtherPRACTICE NPI NUMBER