Basic Information
| Provider Information | |||||||||
| NPI: | 1699139154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LING | ||||||||
| FirstName: | BRANDT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3640 COLONEL GLENN HWY | ||||||||
| Address2: | 117 HEALTH SCIENCES BLDG | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377753458 | ||||||||
| FaxNumber: | 9377753434 | ||||||||
| Practice Location | |||||||||
| Address1: | 3640 COLONEL GLENN HWY | ||||||||
| Address2: | 117 HEALTH SCIENCES BLDG | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377753458 | ||||||||
| FaxNumber: | 9377753434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 02/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | RBT-15-10967 | NV | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.