Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 240770 | KY |
NPI | 1003319484 |
---|---|
Provider Name | Brian Thomas Brentlinger |
First Address | Glencoe, KY 41046-0021 |
Second Address | Glencoe, KY 41046-0021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2018 |
Last Update Date | 13/03/2018 |