Provider Demographics
NPI:1861736035
Name:BROWN, TERRY LENNELL (HUB CERTIFIED)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LENNELL
Last Name:BROWN
Suffix:
Gender:M
Credentials:HUB CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6487 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-1228
Mailing Address - Country:US
Mailing Address - Phone:409-434-4436
Mailing Address - Fax:888-503-0567
Practice Address - Street 1:3115 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-1359
Practice Address - Country:US
Practice Address - Phone:409-842-5005
Practice Address - Fax:888-503-0567
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor