Healthcare Provider Details

I. General information

NPI: 1053035485
Provider Name (Legal Business Name): DAVID RYAN PRIEBE CT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E MARKET ST
AKRON OH
44305-2421
US

IV. Provider business mailing address

725 E MARKET ST
AKRON OH
44305-2421
US

V. Phone/Fax

Practice location:
  • Phone: 330-434-4141
  • Fax:
Mailing address:
  • Phone: 330-434-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2405630-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.181730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: