Provider Demographics
NPI:1922126242
Name:DAVIS, BRIAN M (MS, MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS, MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 N HIGH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3973
Mailing Address - Country:US
Mailing Address - Phone:614-436-0444
Mailing Address - Fax:614-436-1064
Practice Address - Street 1:5701 N HIGH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3973
Practice Address - Country:US
Practice Address - Phone:614-436-0444
Practice Address - Fax:614-436-1064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional