Basic Information
| Provider Information | |||||||||
| NPI: | 1790903466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.A.S., CASE MANAGER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1926 AUTUMN MEADOW TRL | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752323702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722244671 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3330 S LANCASTER RD | ||||||||
| Address2: | ANNEX BUILDING | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752164531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143710474 | ||||||||
| FaxNumber: | 2143713933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.