Provider Demographics
NPI:1720371586
Name:BROWN, CAROL J (BA, PSRS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:BA, PSRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PLAZA
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-2248
Mailing Address - Country:US
Mailing Address - Phone:580-795-7439
Mailing Address - Fax:580-795-7444
Practice Address - Street 1:105 PLAZA
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-2248
Practice Address - Country:US
Practice Address - Phone:580-795-7439
Practice Address - Fax:580-795-7444
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation