Provider Demographics
NPI:1417765405
Name:MOREHOUSE, BRENT
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:MOREHOUSE
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 1:7279 SNOWBALL RUN
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-3212
Mailing Address - Country:US
Mailing Address - Phone:315-664-9046
Mailing Address - Fax:
Practice Address - Street 1:304 E 1ST ST
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2927
Practice Address - Country:US
Practice Address - Phone:315-664-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach