1710632963 NPI number — TYCHELLE MARTINE BROWN LMHP-R

Table of content: TYCHELLE MARTINE BROWN LMHP-R (NPI 1710632963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710632963 NPI number — TYCHELLE MARTINE BROWN LMHP-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
TYCHELLE
Provider Middle Name:
MARTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHP-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710632963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 E LABURNUM AVE STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23222-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-625-1094
Provider Business Practice Location Address Fax Number:
804-362-3630
Provider Enumeration Date:
02/16/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 0704013685 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1982804308 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com