Provider Demographics
NPI:1689038093
Name:FORT BROWNLOW, ROSIE DENICE
Entity Type:Individual
Prefix:
First Name:ROSIE
Middle Name:DENICE
Last Name:FORT BROWNLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSIE
Other - Middle Name:DENICE
Other - Last Name:FORT BROWNLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMHT
Mailing Address - Street 1:2504 BROWNING ROAD 520
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-6022
Mailing Address - Country:US
Mailing Address - Phone:662-455-4141
Mailing Address - Fax:662-455-4193
Practice Address - Street 1:2504 BROWNING ROAD 520
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-6022
Practice Address - Country:US
Practice Address - Phone:662-455-4141
Practice Address - Fax:662-455-4193
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health