Provider Demographics
NPI:1477760601
Name:KIDD, BRIAN (BS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KIDD
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 VINE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4845
Mailing Address - Country:US
Mailing Address - Phone:304-640-3748
Mailing Address - Fax:
Practice Address - Street 1:175 PHILPOT LANE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-254-9262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)