Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | MI | |
Y | 103K00000X | Behavior Analyst | MI | |
N | 106S00000X | Behavior Technician |
NPI | 1003309519 |
---|---|
Provider Name | Tao Chance Brown-Edwards |
First Address | Stuart, FL 34997-7462 |
Second Address | Grand Rapids, MI 49506-3155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2018 |
Last Update Date | 08/07/2019 |