MEDICARE: TYCHELLE MARTINE BROWN LMHP-R

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	0704013685	VA

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	:	1710632963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYCHELLE MARTINE BROWN LMHP-R

Provider Business Mailing Address
First Line	:	3400 DELANO ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-1533
Country	:	US
Telephone Number	:	804-625-1094
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 DELANO ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-1533
Country	:	US
Telephone Number	:	804-625-1094
Fax Number	:

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

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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