Provider Demographics
NPI:1558169797
Name:BROWN, JEFFERY ALLEN
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 WARWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6340
Mailing Address - Country:US
Mailing Address - Phone:214-274-7915
Mailing Address - Fax:
Practice Address - Street 1:3535 VICTORY GROUP WAY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6719
Practice Address - Country:US
Practice Address - Phone:469-287-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional