Healthcare Provider Details

I. General information

NPI: 1093676298
Provider Name (Legal Business Name): TYRA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14724 VENTURA BLVD SUITE 1105
SHERMAN OAKS CA
91403
US

IV. Provider business mailing address

437 N ARDMORE AVE APT 214
LOS ANGELES CA
90004-2653
US

V. Phone/Fax

Practice location:
  • Phone: 424-356-7271
  • Fax:
Mailing address:
  • Phone: 424-356-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: