Provider Information for 1609471960
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Mrs. JA'LISE LYNN BROWN LCSW
Other Names:Former Name:JA'LISE LYNN HANEYSex: Female
NPI: 1609471960
Last Updated: 2023-06-30
Certification Date: 2023-06-30
Certification Date: 2023-06-30
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1609471960 | ||||||||||||
| Enumeration Date | 2020-12-03 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3415 PEMBERTON SQUARE BLVD VICKSBURG, MS 39180-5886 United States Phone: 601-641-9953 | Fax:601-767-2318 | ||||||||||||
| Primary Practice Address | 1500 E WOODROW WILSON AVE JACKSON, MS 39216-5116 United States Phone: 601-641-9953 | Fax:601-767-2318 | ||||||||||||
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