Provider Demographics
NPI:1285241349
Name:BROWN, NICHOLE GABRIELLE (LPC)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:GABRIELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:GABRIELLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5045 THUNDER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6546
Mailing Address - Country:US
Mailing Address - Phone:580-231-1056
Mailing Address - Fax:
Practice Address - Street 1:5045 THUNDER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6546
Practice Address - Country:US
Practice Address - Phone:580-231-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health