Provider Demographics
NPI:1265589535
Name:BROWN, LOLA COXFORD (PHD)
Entity type:Individual
Prefix:DR
First Name:LOLA
Middle Name:COXFORD
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31011 VIA MIRADOR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1743
Mailing Address - Country:US
Mailing Address - Phone:949-443-2923
Mailing Address - Fax:949-443-2922
Practice Address - Street 1:23832 ROCKFIELD BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2805
Practice Address - Country:US
Practice Address - Phone:949-768-8109
Practice Address - Fax:949-830-5530
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17830103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist