Provider Demographics
NPI:1578185740
Name:TURK, BRIAN DAVID (MSSA, LISA, LICDC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:TURK
Suffix:
Gender:M
Credentials:MSSA, LISA, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-0298
Mailing Address - Country:US
Mailing Address - Phone:440-710-3288
Mailing Address - Fax:440-563-9619
Practice Address - Street 1:2863 STATE ROUTE 45 N
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9352
Practice Address - Country:US
Practice Address - Phone:440-710-3288
Practice Address - Fax:440-563-9619
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151050101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty