Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4871 | WI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301011664 | MI |
NPI | 1093886723 |
---|---|
Provider Name | Douglas Clyde Brey |
First Address | Oshkosh, WI 54901-5030 |
Second Address | Oshkosh, WI 54901-5030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 19/09/2016 |