Provider Demographics
NPI:1386694032
Name:BRICKEY, MICHAEL (PH D)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BRICKEY
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2309
Mailing Address - Country:US
Mailing Address - Phone:614-237-4556
Mailing Address - Fax:
Practice Address - Street 1:865 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2309
Practice Address - Country:US
Practice Address - Phone:614-237-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0512145Medicaid
OHP00174919OtherRAILROAD MEDICARE
OH0512145Medicaid
OHCP29992Medicare PIN