Provider Demographics
NPI:1548878259
Name:BROWN, TYLER LANEY
Entity type:Individual
Prefix:MISS
First Name:TYLER
Middle Name:LANEY
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 1:6528 E 101ST ST STE D1
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6754
Mailing Address - Country:US
Mailing Address - Phone:918-861-1662
Mailing Address - Fax:
Practice Address - Street 1:6528 E 101ST ST STE D1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6754
Practice Address - Country:US
Practice Address - Phone:918-861-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5531103K00000X
OK1-22-62872103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst