Healthcare Provider Details

I. General information

NPI: 1841517919
Provider Name (Legal Business Name): BRIES ERIK DEERROSE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 NORTHLAKE DR SUITE 230
CINCINNATI OH
45249-1650
US

IV. Provider business mailing address

11500 NORTHLAKE DR SUITE 230
CINCINNATI OH
45249-1650
US

V. Phone/Fax

Practice location:
  • Phone: 513-247-2814
  • Fax:
Mailing address:
  • Phone: 513-247-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPSY.0004248
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0004248
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: