Provider Demographics
NPI:1891303301
Name:BROWN, TEVIN ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:TEVIN
Middle Name:ALEXANDER
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3296 WESTERVILLE RD UNIT 469
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3790
Mailing Address - Country:US
Mailing Address - Phone:614-214-3793
Mailing Address - Fax:
Practice Address - Street 1:3296 WESTERVILLE RD UNIT 469
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3790
Practice Address - Country:US
Practice Address - Phone:614-214-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
OH12365844103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician