Healthcare Provider Details

I. General information

NPI: 1790338937
Provider Name (Legal Business Name): JOSEPH MICHAEL BRETZFELDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date: 11/12/2020
Reactivation Date: 11/18/2020

III. Provider practice location address

1 ELIZABETH PL
DAYTON OH
45417-3445
US

IV. Provider business mailing address

1 ELIZABETH PL
DAYTON OH
45417-3445
US

V. Phone/Fax

Practice location:
  • Phone: 937-813-1737
  • Fax:
Mailing address:
  • Phone: 937-813-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162695
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2406448
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: