Provider Demographics
NPI:1750096178
Name:SHREVE, BRENT
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SHREVE
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 1:1628 E. DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-750-8236
Mailing Address - Fax:937-600-6071
Practice Address - Street 1:9314 RYDER DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2000
Practice Address - Country:US
Practice Address - Phone:937-365-7455
Practice Address - Fax:937-600-6071
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician