MEDICARE: TIFFANYE TEAGARDEN-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	101Y00000X	Counselor	6401013040	MI
2	106H00000X	Marriage & Family Therapist	4101006543	MI
3	101YP2500X	Professional Counselor	6401013040	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13645747	OTHER	MI	CAQH

General Provider Information

NPI Number	:	1225374937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANYE TEAGARDEN-BROWN

Provider Business Mailing Address
First Line	:	PO BOX 663
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48099-0663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2242 S TELEGRAPH RD STE 209
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0218
Country	:	US
Telephone Number	:	248-797-1188
Fax Number	:	248-847-1346

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

Provider Enumeration Date	:	12/27/2012
Last Update Date	:	09/18/2020

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Directions to “ TIFFANYE TEAGARDEN-BROWN ” Practice Location

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