Provider Demographics
NPI:1861950404
Name:BROWN, TAMARA JENNIFER (LMSW, LCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:JENNIFER
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 COBBLEFIELD CIR SE APT 9
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7667
Mailing Address - Country:US
Mailing Address - Phone:210-215-1665
Mailing Address - Fax:
Practice Address - Street 1:2663 44TH ST SW STE 106
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4189
Practice Address - Country:US
Practice Address - Phone:616-414-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534041041C0700X
MI68010959471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical