Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | E0800347 | OH |
NPI | 1003215773 |
---|---|
Provider Name | Mr. Brian Spears |
First Address | Cincinnati, OH 45236-4416 |
Second Address | Cincinnati, OH 45236-4416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E0800347 | LICENSE (01) | OH |