Provider Demographics
NPI:1487715678
Name:BROWN, TINA ALICEA (LPC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:ALICEA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 DENVER DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4423
Mailing Address - Country:US
Mailing Address - Phone:254-458-8988
Mailing Address - Fax:512-556-2191
Practice Address - Street 1:1003 WEST HWY 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522
Practice Address - Country:US
Practice Address - Phone:254-458-8988
Practice Address - Fax:512-556-2191
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional