Provider Demographics
NPI:1578885927
Name:BROWN, CYNTHIA DENISE (LCDC, LMSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DENISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCDC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 E GORE BLVD APT 1118
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-6859
Mailing Address - Country:US
Mailing Address - Phone:214-604-2392
Mailing Address - Fax:
Practice Address - Street 1:711 ROARING SPRINGS DR
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-7925
Practice Address - Country:US
Practice Address - Phone:214-604-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8271101YA0400X
TX52633104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1578885927OtherLMSW, LCDC