Provider Demographics
NPI:1720129463
Name:DICK, BRIAN EMERSON (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EMERSON
Last Name:DICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 QUINTER RD
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16130-1417
Mailing Address - Country:US
Mailing Address - Phone:724-284-9440
Mailing Address - Fax:724-284-9441
Practice Address - Street 1:100 BRUGH AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-6410
Practice Address - Country:US
Practice Address - Phone:724-284-9440
Practice Address - Fax:724-284-9441
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7246685OtherAETNA
PA1669967OtherHIGHMARK KHPW