Provider Demographics
NPI:1003346578
Name:WYMBS, BRIAN T (PHD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:WYMBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 PORTER HALL
Mailing Address - Street 2:OHIO UNIVERSITY
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 OHIO UNIVERSITY DEPT OF PSYCHOLOGY
Practice Address - Street 2:PORTER HALL ROOM 002
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2942
Practice Address - Country:US
Practice Address - Phone:740-593-0902
Practice Address - Fax:740-593-4790
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH7076103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical