Provider Demographics
NPI:1962177337
Name:BROWN, IYANNA DENISE (LMSW)
Entity type:Individual
Prefix:
First Name:IYANNA
Middle Name:DENISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N ROCK ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2228
Mailing Address - Country:US
Mailing Address - Phone:870-942-3135
Mailing Address - Fax:
Practice Address - Street 1:510 W CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2016
Practice Address - Country:US
Practice Address - Phone:870-484-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11356-M103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150049791Medicaid