Provider Demographics
NPI:1619409885
Name:RICHARDSON, BRENT GENTRY (LPCC-S)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:GENTRY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2919
Mailing Address - Country:US
Mailing Address - Phone:513-470-5174
Mailing Address - Fax:
Practice Address - Street 1:3800 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1035
Practice Address - Country:US
Practice Address - Phone:513-745-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health