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NPI Code Detail

MEDICARE: BRENDAN TEKULVE CPRS, CDCA

MEDICARE: BRENDAN TEKULVE CPRS, CDCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.193340OH
2175T00000XPeer SpecialistAPS.004334OH

General Provider Information

NPI Number : 1164230124
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDAN TEKULVE CPRS, CDCA
Provider Business Mailing Address
First Line : 1525 BURDETTE CT
Second Line :
City : CINCINNATI
State : OH
Zip : 45206-2113
Country : US
Telephone Number : 513-704-9587
Fax Number :
Provider Business Practice Location Address
First Line : 3304 COLERAIN AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45225-1316
Country : US
Telephone Number : 513-704-9587
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2024
Last Update Date : 09/19/2025

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