Healthcare Provider Details

I. General information

NPI: 1386963882
Provider Name (Legal Business Name): DAVID BREWER LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 MOUNT CARMEL TOBASCO RD SUITE 102
CINCINNATI OH
45255-3400
US

IV. Provider business mailing address

6072 TOSHA DR
BURLINGTON KY
41005-9302
US

V. Phone/Fax

Practice location:
  • Phone: 859-653-2461
  • Fax:
Mailing address:
  • Phone: 859-653-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.0601042
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: