Provider Demographics
NPI:1538328604
Name:BROWN, BRENDA D (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6607
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-0118
Mailing Address - Country:US
Mailing Address - Phone:817-964-0107
Mailing Address - Fax:
Practice Address - Street 1:3109 FALL CREEK HWY
Practice Address - Street 2:STE 5
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7929
Practice Address - Country:US
Practice Address - Phone:817-964-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional