1912442823 NPI number — ANESHA ROSHON BROWN-MORRIS LMT

Table of content: AMANDA MILLER LMHC (NPI 1114616646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912442823 NPI number — ANESHA ROSHON BROWN-MORRIS LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN-MORRIS
Provider First Name:
ANESHA
Provider Middle Name:
ROSHON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912442823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 REXFORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78723-4822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-921-4414
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6406 NORTH IH 35, SUITE 2300
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-790-4325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MT126532 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)