Provider Demographics
NPI:1699173963
Name:BROWN, ROSLYN A (MA, LPC, LCDC)
Entity type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SCARLET LN
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7471
Mailing Address - Country:US
Mailing Address - Phone:912-492-8451
Mailing Address - Fax:
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 201-A1
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9166
Practice Address - Country:US
Practice Address - Phone:254-833-5089
Practice Address - Fax:254-863-6031
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13613101YA0400X
TX75653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374114201Medicaid