Provider Demographics
NPI:1578949095
Name:BROWN, ROYAL (MA, LCDC)
Entity Type:Individual
Prefix:
First Name:ROYAL
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10955 WURZBACH RD. #303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2540
Mailing Address - Country:US
Mailing Address - Phone:817-480-4152
Mailing Address - Fax:
Practice Address - Street 1:3780 NW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3622
Practice Address - Country:US
Practice Address - Phone:210-736-4405
Practice Address - Fax:210-736-4407
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13081101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)