MEDICARE: MILES TIMOTHY BROWN SPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	E0003623	OH
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1285748020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILES TIMOTHY BROWN SPCC

Provider Business Mailing Address
First Line	:	1404 PARK AVE W STE 2
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44906-2719
Country	:	US
Telephone Number	:	419-522-6191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 PARK AVE W STE 2
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44906-2719
Country	:	US
Telephone Number	:	419-522-6191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	10/24/2023

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Directions to “ MILES TIMOTHY BROWN SPCC” Practice Location

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