Provider Demographics
NPI:1083794614
Name:BROWN, TINA LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 PARK PLAZA AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2288
Mailing Address - Country:US
Mailing Address - Phone:502-339-2442
Mailing Address - Fax:888-384-3831
Practice Address - Street 1:9720 PARK PLAZA AVE.
Practice Address - Street 2:SUITE #102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2289
Practice Address - Country:US
Practice Address - Phone:502-339-2442
Practice Address - Fax:888-384-3831
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPSYPST00218953103T00000X
OH6288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical