Provider Demographics
NPI:1689762304
Name:BROWN, TAMMY (LMSW-ACP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW-ACP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:GEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-ACP
Mailing Address - Street 1:206 E LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4357
Mailing Address - Country:US
Mailing Address - Phone:512-327-5001
Mailing Address - Fax:
Practice Address - Street 1:206 E LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4357
Practice Address - Country:US
Practice Address - Phone:512-327-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00237POtherBCBS
TX00237PMedicare ID - Type Unspecified