MEDICARE: THODIS BELL BROWN SR.

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	103TH0100X	Health Service Psychologist		MI

General Provider Information

NPI Number	:	1487593406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THODIS BELL BROWN SR.

Provider Business Mailing Address
First Line	:	6114 HARTFORD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48210-1369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15400 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-4124
Country	:	US
Telephone Number	:	248-974-7417
Fax Number	:

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

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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