Provider Demographics
NPI:1881231876
Name:ROSLYN ANTONNETT BROWN
Entity Type:Organization
Organization Name:ROSLYN ANTONNETT BROWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:ANTONNETT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LCDC
Authorized Official - Phone:254-833-5089
Mailing Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 201A1
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-9121
Mailing Address - Country:US
Mailing Address - Phone:254-833-5089
Mailing Address - Fax:254-863-6031
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 201A1
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9121
Practice Address - Country:US
Practice Address - Phone:254-833-5089
Practice Address - Fax:254-863-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty