Provider Demographics
NPI:1295517225
Name:BROWN, TAJAH MONAY
Entity type:Individual
Prefix:
First Name:TAJAH
Middle Name:MONAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83680 NOVILLA DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-2895
Mailing Address - Country:US
Mailing Address - Phone:760-391-8801
Mailing Address - Fax:
Practice Address - Street 1:83680 NOVILLA DR
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-2895
Practice Address - Country:US
Practice Address - Phone:760-391-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst