Provider Demographics
NPI:1336555929
Name:BROWN, TIMOTHY (MS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:1305 EAST NEW INDIAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-1600
Mailing Address - Country:US
Mailing Address - Phone:630-966-4290
Mailing Address - Fax:
Practice Address - Street 1:1419 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2873
Practice Address - Country:US
Practice Address - Phone:815-730-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional