Provider Demographics
NPI:1780269407
Name:BROWN, JIMMY EDWARD (MS CAT)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:EDWARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:MS CAT
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 88
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0088
Mailing Address - Country:US
Mailing Address - Phone:601-824-0342
Mailing Address - Fax:601-824-0349
Practice Address - Street 1:3112 SIMPSON HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3076
Practice Address - Country:US
Practice Address - Phone:601-847-2623
Practice Address - Fax:601-847-3701
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)