Provider Demographics
NPI:1871504639
Name:BROWN, LARRY HERBERT (PHD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:HERBERT
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 MCKNIGHT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-2323
Mailing Address - Country:US
Mailing Address - Phone:713-726-1003
Mailing Address - Fax:
Practice Address - Street 1:3801 KIRBY DR
Practice Address - Street 2:SUITE 246
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4100
Practice Address - Country:US
Practice Address - Phone:713-533-1559
Practice Address - Fax:713-589-3155
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00SD40Medicare UPIN
00SD40Medicare ID - Type Unspecified