Provider Demographics
NPI:1205305810
Name:BROWN, BOBBIE ANNE (MED, LPC)
Entity type:Individual
Prefix:
First Name:BOBBIE ANNE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W VICKERY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5672
Mailing Address - Country:US
Mailing Address - Phone:817-609-6733
Mailing Address - Fax:
Practice Address - Street 1:3901 W VICKERY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5672
Practice Address - Country:US
Practice Address - Phone:817-609-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X, 101YM0800X
TX77642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health