Provider Demographics
NPI:1649464157
Name:BROWN, TERRY DALE JR (PHD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:DALE
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S MEMORIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-1272
Mailing Address - Country:US
Mailing Address - Phone:765-465-3387
Mailing Address - Fax:888-441-0851
Practice Address - Street 1:2020 S MEMORIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1272
Practice Address - Country:US
Practice Address - Phone:765-465-3387
Practice Address - Fax:888-441-0851
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical