Provider Demographics
NPI:1235424946
Name:DEWYRE, BRIAN (PCC-S)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DEWYRE
Suffix:
Gender:M
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20545 CENTER RIDGE RD STE 448
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3423
Mailing Address - Country:US
Mailing Address - Phone:440-554-4062
Mailing Address - Fax:440-356-0580
Practice Address - Street 1:20545 CENTER RIDGE RD STE 448
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3423
Practice Address - Country:US
Practice Address - Phone:440-554-4062
Practice Address - Fax:440-356-0580
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0002815101Y00000X, 101YA0400X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional