Provider Demographics
NPI:1740444702
Name:BROWN, TIMOTHY MARTEL (LCSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARTEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209B BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-4726
Mailing Address - Country:US
Mailing Address - Phone:979-775-6019
Mailing Address - Fax:
Practice Address - Street 1:1209B BAKER AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-4726
Practice Address - Country:US
Practice Address - Phone:979-775-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical