Healthcare Provider Details

I. General information

NPI: 1063920155
Provider Name (Legal Business Name): DAVID TYRONE BRAND JR. LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 BEECHMONT AVE
CINCINNATI OH
45230-2907
US

IV. Provider business mailing address

3843 DAVIS AVE
CINCINNATI OH
45211-4834
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-6630
  • Fax: 513-231-3573
Mailing address:
  • Phone: 513-546-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1800869
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2102254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: