Provider Demographics
NPI:1619579299
Name:BROWN, CLINIQUE (SPIRITUAL DR / DR)
Entity Type:Individual
Prefix:
First Name:CLINIQUE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:SPIRITUAL DR / DR
Other - Prefix:
Other - First Name:OG
Other - Middle Name:
Other - Last Name:BECKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:633 E FERNHURST DR STE 1202
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1590
Mailing Address - Country:US
Mailing Address - Phone:281-617-9958
Mailing Address - Fax:
Practice Address - Street 1:505 W SAM HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099
Practice Address - Country:US
Practice Address - Phone:281-617-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
777OtherN/A