Provider Demographics
NPI:1699198572
Name:SLAUGHTER, BRIAN (BS, MS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 FLORA LEE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3465
Mailing Address - Country:US
Mailing Address - Phone:708-997-1492
Mailing Address - Fax:
Practice Address - Street 1:2608 SUMMER WIND DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5215
Practice Address - Country:US
Practice Address - Phone:708-997-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist