Provider Demographics
NPI:1710856646
Name:BROWN, LEIA CAILYN
Entity type:Individual
Prefix:
First Name:LEIA
Middle Name:CAILYN
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0068
Mailing Address - Country:US
Mailing Address - Phone:662-205-0098
Mailing Address - Fax:662-495-4079
Practice Address - Street 1:5699 GETWELL RD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7312
Practice Address - Country:US
Practice Address - Phone:662-205-0098
Practice Address - Fax:662-495-4079
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM10646104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker