Provider Demographics
NPI:1043690191
Name:BRENNER, RICK SCOTT
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:SCOTT
Last Name:BRENNER
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 1:7593 LORIMAR DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8300
Mailing Address - Country:US
Mailing Address - Phone:740-973-6784
Mailing Address - Fax:
Practice Address - Street 1:90 N EAST ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1170
Practice Address - Country:US
Practice Address - Phone:614-920-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1277534103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool