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General NPI Number Information
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NPI Number | 1033523915
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Entity Type | Individual
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Provider Name | WADE BRILL PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 1001 OLIVESBURG RD
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City | MANSFIELD
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State | OH
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Zip | 44905-1228
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Country | US
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Telephone | 419-526-2100
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Fax | 419-521-2822
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Provider Business Mailing Address
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Address Line | 1001 OLIVESBURG RD
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City | MANSFIELD
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State | OH
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Zip | 44905-1228
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Country | US
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Telephone | 419-526-2100
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Fax | 419-521-2822
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 4969
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4969
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License Number State | OH
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