Provider Demographics
NPI:1770881500
Name:BROWN, BINTA YAISA (LPC)
Entity type:Individual
Prefix:
First Name:BINTA
Middle Name:YAISA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BINTA
Other - Middle Name:YAISA
Other - Last Name:LORDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 ESTHER BLVD
Mailing Address - Street 2:# C
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-6739
Mailing Address - Country:US
Mailing Address - Phone:936-615-6862
Mailing Address - Fax:
Practice Address - Street 1:115 ESTHER BLVD
Practice Address - Street 2:# C
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-6739
Practice Address - Country:US
Practice Address - Phone:936-615-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional