Provider Demographics
NPI:1720007388
Name:BROWN, BEVERLY (LAPSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CRITTON DR
Mailing Address - Street 2:
Mailing Address - City:PIPERTON
Mailing Address - State:TN
Mailing Address - Zip Code:38017-5373
Mailing Address - Country:US
Mailing Address - Phone:901-674-9726
Mailing Address - Fax:
Practice Address - Street 1:1940 HIGHWAY 196 S
Practice Address - Street 2:
Practice Address - City:PIPERTON
Practice Address - State:TN
Practice Address - Zip Code:38017-5726
Practice Address - Country:US
Practice Address - Phone:901-674-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNASW128101YM0800X, 104100000X
TNCSW4357104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCSW0000004357OtherSTATE LIC