James J Brown, LCSW LPC

Individual provider Active NPI Mental Health Counselor · Jacksonville, TX

NPI 1144217290 · NPPES record last updated Jul 24, 2008

Key facts

NPI
1144217290
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
License
LCSW00357 (TX)
Practice address
703 S Main St
Jacksonville, TX 75766-2428
Phone
(903) 586-6736
Fax
(903) 586-2412
NPI assigned
Oct 4, 2005
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
LCSW00357TXMDMental Health Counselor
LPC004887TXMDMental Health Counselor
357TXMDProfessional Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LCSW00357 TX Yes
Mental Health Counselor 101YM0800X LPC004887 TX

Addresses

Primary practice location

703 S Main St
Jacksonville, TX 75766-2428

Mailing address

703 S Main St
Jacksonville, TX 75766-2428
Phone (903) 586-6736

Other identifiers

IdentifierTypeStateIssuer
095305101MedicaidTX
095305103MedicaidTX
095305104MedicaidTX

Other providers in Jacksonville, TX

All providers in Jacksonville, TX · Mental Health Counselor in Texas

Sources for this page

Verify at the official NPI Registry.