Provider Demographics
NPI:1063045102
Name:BROWN, IMANI (MED, LPC-INTERN)
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 STRADA CIR STE 220
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3209
Mailing Address - Country:US
Mailing Address - Phone:214-686-5856
Mailing Address - Fax:
Practice Address - Street 1:600 STRADA CIR STE 220
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3209
Practice Address - Country:US
Practice Address - Phone:214-686-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82553101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health