Provider Demographics
NPI:1992892004
Name:BROWN, LAUREL (PHD)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2511
Mailing Address - Country:US
Mailing Address - Phone:615-321-5767
Mailing Address - Fax:615-321-5768
Practice Address - Street 1:110 30TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2511
Practice Address - Country:US
Practice Address - Phone:615-321-5767
Practice Address - Fax:615-321-5768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002433103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist