Provider Demographics
NPI:1962388769
Name:TRAMMELL-BROWN, OLYMPIA WYNETTE
Entity type:Individual
Prefix:MS
First Name:OLYMPIA
Middle Name:WYNETTE
Last Name:TRAMMELL-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 TIM FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-3226
Mailing Address - Country:US
Mailing Address - Phone:915-691-7915
Mailing Address - Fax:
Practice Address - Street 1:1605 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3117
Practice Address - Country:US
Practice Address - Phone:575-527-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99233101YM0800X
NMCBT-2025-0570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health