Provider Demographics
NPI:1740285444
Name:BROWN, TIMOTHY (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:24724 W EAMES ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5446
Mailing Address - Country:US
Mailing Address - Phone:815-467-1342
Mailing Address - Fax:
Practice Address - Street 1:24724 W EAMES ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5446
Practice Address - Country:US
Practice Address - Phone:815-467-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL330210Medicare ID - Type Unspecified