Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | P.08007 | OH |
N | 103T00000X | Psychologist | P.08007 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | P.08007 | OH |
N | 103TB0200X | Cognitive & Behavioral Psychologist | P.08007 | OH |
Y | 103G00000X | Clinical Psychologist | P.08007 | OH |
Y | 103TC0700X | Clinical Psychologist | P.08007 | OH |
N | 103TH0100X | Health Service | P.08007 | OH |
NPI | 1316566474 |
---|---|
Provider Name | Dr. Ty Brumback |
First Address | Cincinnati, OH 45230-4031 |
Second Address | Cincinnati, OH 45208-1626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 09/04/2020 |