Provider Demographics
NPI:1013352400
Name:BROWN, LULA MAE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LULA
Middle Name:MAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:LULA
Other - Middle Name:MAE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:MATT 25 1200 NORTH THORNTON STREET
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:575-763-4400
Mailing Address - Fax:
Practice Address - Street 1:MATT 25 1200 NORTH THORNTON STREET
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-763-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0154001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health