Provider Demographics
NPI:1245267111
Name:BROWN, TAMMERA SUSAN (MA, LPC)
Entity type:Individual
Prefix:
First Name:TAMMERA
Middle Name:SUSAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 APPLE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2904
Mailing Address - Country:US
Mailing Address - Phone:979-820-1137
Mailing Address - Fax:979-774-5011
Practice Address - Street 1:1713 BROADMOOR DR STE 406
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5220
Practice Address - Country:US
Practice Address - Phone:979-776-0930
Practice Address - Fax:979-776-0930
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11313675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0263212-01Medicaid
TX2879 LCOtherBLUE CROSS NUMBER