Healthcare Provider Details

I. General information

NPI: 1275156937
Provider Name (Legal Business Name): BRIANNA NICOLE KILBANE BHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37901 QUAIL HOLW
AVON OH
44011-4722
US

IV. Provider business mailing address

5642 HAMILTON AVE
CINCINNATI OH
45224-3114
US

V. Phone/Fax

Practice location:
  • Phone: 440-840-8670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: