Provider Demographics
NPI:1942568290
Name:BROWN, TOMMY JAMAL
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:JAMAL
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 NE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1601
Mailing Address - Country:US
Mailing Address - Phone:405-473-6678
Mailing Address - Fax:
Practice Address - Street 1:338 NE 60TH ST
Practice Address - Street 2:338 NE 60TH STREET
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1601
Practice Address - Country:US
Practice Address - Phone:405-473-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKH080304931103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst