Basic Information
| Provider Information | |||||||||
| NPI: | 1750041323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JARON | ||||||||
| MiddleName: | RAKEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 TWIN PINE DR | ||||||||
| Address2: | |||||||||
| City: | PEARL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392086396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019063283 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E WOODROW WILSON AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392165116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013624471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2021 | ||||||||
| LastUpdateDate: | 12/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C9151 | MS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.