Provider Demographics
NPI:1497261044
Name:BROWN, TYLER J (CDCA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:CDCA
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 284
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-0284
Mailing Address - Country:US
Mailing Address - Phone:740-688-9093
Mailing Address - Fax:
Practice Address - Street 1:22664 STATE ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663
Practice Address - Country:US
Practice Address - Phone:740-858-6690
Practice Address - Fax:740-858-6693
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OH167053101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health