Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 73973 | TX |
NPI | 1003340332 |
---|---|
Provider Name | Dara Brown |
First Address | Big Spring, TX 79720-2529 |
Second Address | Big Spring, TX 79720-4122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2017 |
Last Update Date | 13/04/2017 |