Provider Demographics
NPI:1881323574
Name:ELIASON, BRIAN ALAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALAN
Last Name:ELIASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-0298
Mailing Address - Country:US
Mailing Address - Phone:440-228-1371
Mailing Address - Fax:440-563-3421
Practice Address - Street 1:2863 STATE ROUTE 45 N
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9352
Practice Address - Country:US
Practice Address - Phone:440-228-1371
Practice Address - Fax:440-563-3421
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional