Provider Demographics
NPI:1871542381
Name:BROWN, IRIS LYNNE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:IRIS
Middle Name:LYNNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 3RD AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701
Mailing Address - Country:US
Mailing Address - Phone:334-875-2100
Mailing Address - Fax:334-418-6540
Practice Address - Street 1:1017 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6780
Practice Address - Country:US
Practice Address - Phone:334-875-2100
Practice Address - Fax:334-418-6540
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL948C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6291861OtherUBH PROVIDER-BASIC SERVIC
AL6292861OtherUBH PROVIDER #-PLUS SERVI
AL6292861OtherUBH PROVIDER #-PLUS SERVI