Healthcare Provider Details

I. General information

NPI: 1447020755
Provider Name (Legal Business Name): BRIAN LAWSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WESTCHESTER DR STE 5
AUSTINTOWN OH
44515-3965
US

IV. Provider business mailing address

2980 BELMONT AVE
YOUNGSTOWN OH
44505-1834
US

V. Phone/Fax

Practice location:
  • Phone: 330-270-1400
  • Fax: 330-270-1404
Mailing address:
  • Phone: 330-759-0276
  • Fax: 330-759-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2506782
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: