Provider Demographics
NPI:1831588557
Name:SEQUOIA BROWN
Entity type:Organization
Organization Name:SEQUOIA BROWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEQUOIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC LCDC
Authorized Official - Phone:903-517-4063
Mailing Address - Street 1:1019 S COLLEGIATE DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6309
Mailing Address - Country:US
Mailing Address - Phone:903-517-4063
Mailing Address - Fax:
Practice Address - Street 1:1019 S COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6309
Practice Address - Country:US
Practice Address - Phone:903-517-4063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5369251S00000X
TX72961251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20044900BMedicaid