Healthcare Provider Details

I. General information

NPI: 1881529022
Provider Name (Legal Business Name): BRANDON WHITE INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 GLENSPRINGS DR STE 301
CINCINNATI OH
45246-2354
US

IV. Provider business mailing address

11395 GRAVENHURST DR
CINCINNATI OH
45231-1213
US

V. Phone/Fax

Practice location:
  • Phone: 513-570-4068
  • Fax: 513-672-1028
Mailing address:
  • Phone: 513-953-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2607879-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: