Provider Demographics
NPI:1285650572
Name:BREWER, BRIAN RICHARD (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RICHARD
Last Name:BREWER
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 SIOUX TRL NW
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-9077
Mailing Address - Country:US
Mailing Address - Phone:952-496-6167
Mailing Address - Fax:952-233-4255
Practice Address - Street 1:2330 SIOUX TRL NW
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-9077
Practice Address - Country:US
Practice Address - Phone:952-496-6167
Practice Address - Fax:952-233-4255
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist