Individual
DR. MARY BROWN-JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D.
Contact information
Practice address
501 CANVAS CT, CROWLEY, TX 76036-4338
(817) 996-3138
Mailing address
501 CANVAS CT, CROWLEY, TX 76036-4338
18179963138
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
16071202
TX
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
16071202
TX
Other
Enumeration date
09/22/2017
Last updated
09/22/2017
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