Provider Demographics
NPI:1679262760
Name:COOKE BROWN, CRYSTAL JOY (LMSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JOY
Last Name:COOKE BROWN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 795171
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-5171
Mailing Address - Country:US
Mailing Address - Phone:757-582-6786
Mailing Address - Fax:
Practice Address - Street 1:303 S HIGHWAY 78 STE 100
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3957
Practice Address - Country:US
Practice Address - Phone:469-342-3468
Practice Address - Fax:469-342-3466
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical