Individual provider Active NPI

Stella W. Brown, PH.D.

  • Counseling Psychologist
  • Jackson, MS
National Provider Identifier
1144233750
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
35-571 Issued in MS
Practice address
2614 Southerland St
Suite One
Jackson, MS 39216-4858
Phone
(601) 362-2624
Fax
(601) 362-2622
NPI assigned
Aug 14, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 35-571 MS Primary

Addresses

Primary practice location

2614 Southerland St
Suite One
Jackson, MS 39216-4858

Mailing address

2614 Southerland St
Suite One
Jackson, MS 39216-4858
Phone (601) 362-2624

Other identifiers 1

IdentifierTypeStateIssuer
00117542MedicaidMS

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
35-571MSMDCounseling Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144233750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2614 SOUTHERLAND ST",
            "address_2": "SUITE ONE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164858",
            "telephone_number": "601-362-2624",
            "fax_number": "601-362-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2614 SOUTHERLAND ST",
            "address_2": "SUITE ONE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164858",
            "telephone_number": "601-362-2624",
            "fax_number": "601-362-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "STELLA",
        "middle_name": "W.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MS",
            "license": "35-571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117542",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.