Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 7076 | OH |
Y | 103TC0700X | Clinical Psychologist | 7076 | OH |
NPI | 1003346578 |
---|---|
Provider Name | Brian T. Wymbs |
First Address | Athens, OH 45701 |
Second Address | Athens, OH 45701-2942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2017 |
Last Update Date | 15/06/2017 |