MEDICARE: LEVI BROWN

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	171M00000X	Case Manager/Care Coordinator		AR
2	106S00000X	Behavior Technician	RBT-22-218627	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134678782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEVI BROWN

Provider Business Mailing Address
First Line	:	PO BOX 1589
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72018-1589
Country	:	US
Telephone Number	:	501-315-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 TECH BLVD STE 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7863
Country	:	US
Telephone Number	:	813-547-5413
Fax Number	:

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

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	06/21/2022

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Directions to “ LEVI BROWN ” Practice Location

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