Provider Demographics
NPI:1023148277
Name:BROWN, LISA B (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6284 RUCKER RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4865
Mailing Address - Country:US
Mailing Address - Phone:317-475-1389
Mailing Address - Fax:317-475-9089
Practice Address - Street 1:6284 RUCKER RD
Practice Address - Street 2:SUITE N
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4865
Practice Address - Country:US
Practice Address - Phone:317-475-1389
Practice Address - Fax:317-475-9089
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041735A103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth