MEDICARE: MRS. TANYA ROSALEE BROWN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	171M00000X	Case Manager/Care Coordinator
5	171W00000X	Contractor
6	101Y00000X	Counselor

General Provider Information

NPI Number	:	1114618212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TANYA ROSALEE BROWN

Provider Business Mailing Address
First Line	:	2618 BUTTERFIELD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5881
Country	:	US
Telephone Number	:	347-818-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	2618 BUTTERFIELD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5881
Country	:	US
Telephone Number	:	347-818-0386
Fax Number	:

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

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	07/05/2023

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