Provider Demographics
NPI:1265554398
Name:BROWN, WILLIE JEWEL (LCSW, PHD)
Entity type:Individual
Prefix:MRS
First Name:WILLIE
Middle Name:JEWEL
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:DR
Other - First Name:WILLIE
Other - Middle Name:JEWEL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW
Mailing Address - Street 1:301 WALNUT RUN ST
Mailing Address - Street 2:301 WALNUT RUN STREET
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-9729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:409-383-1214
Practice Address - Street 1:255 S. WHEELER STREET
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951
Practice Address - Country:US
Practice Address - Phone:409-384-1495
Practice Address - Fax:409-383-1214
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00S1421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical