Healthcare Provider Details

I. General information

NPI: 1700739158
Provider Name (Legal Business Name): TOMMIE DERRILE BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 N FOREST AVE
KANSAS CITY MO
64155-1950
US

IV. Provider business mailing address

10431 N FOREST AVE
KANSAS CITY MO
64155-1950
US

V. Phone/Fax

Practice location:
  • Phone: 816-824-4789
  • Fax:
Mailing address:
  • Phone: 816-508-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025006975
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: