Provider Demographics
NPI:1801238225
Name:SPEESE, BRIAN EDWARD (BA,QMHP)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EDWARD
Last Name:SPEESE
Suffix:
Gender:M
Credentials:BA,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W MAIN ST
Mailing Address - Street 2:SUITE M-01
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3694
Mailing Address - Country:US
Mailing Address - Phone:919-530-8888
Mailing Address - Fax:919-530-1011
Practice Address - Street 1:123 W MAIN ST
Practice Address - Street 2:SUITE M-01
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3694
Practice Address - Country:US
Practice Address - Phone:919-530-8888
Practice Address - Fax:919-530-1011
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-565101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)