Provider Demographics
NPI:1861375099
Name:BILLINGSLEY, BRENT LAVELLE
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:LAVELLE
Last Name:BILLINGSLEY
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 1:915 MILLERS RUN CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8647
Mailing Address - Country:US
Mailing Address - Phone:513-200-5228
Mailing Address - Fax:
Practice Address - Street 1:915 MILLERS RUN CT
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8647
Practice Address - Country:US
Practice Address - Phone:513-200-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator