Provider Demographics
NPI:1336744499
Name:RIKE, BRODY SCOTT
Entity type:Individual
Prefix:
First Name:BRODY
Middle Name:SCOTT
Last Name:RIKE
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 1:175 LAKENGREN DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2870
Mailing Address - Country:US
Mailing Address - Phone:937-825-2736
Mailing Address - Fax:
Practice Address - Street 1:1900 FAIRGROVE AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-1966
Practice Address - Country:US
Practice Address - Phone:513-785-4895
Practice Address - Fax:513-785-4896
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional