Provider Demographics
NPI:1952709800
Name:BRICKNER, KURT (PSYD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:BRICKNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5914
Mailing Address - Country:US
Mailing Address - Phone:419-996-4008
Mailing Address - Fax:419-996-4007
Practice Address - Street 1:770 W HIGH ST STE 300
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5914
Practice Address - Country:US
Practice Address - Phone:419-996-4008
Practice Address - Fax:419-996-4007
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7239103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical