Doctor Name: | MR. BRIAN LEE DYKE |
NPI Number: | 1144615626 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC |
License Number: | 302794 |
Business Practice Address: | 1410 S Ferry Rd Anoka, MN - 553032164 |
Business Phone Number: | 7634527007 |
Business Fax Number: | |
Mailing Address: | 1706 Fremont Ave N, MINNEAPOLIS |
State: | MN |
Postal Code: | 554113236 |
Phone Number: | 6123628931 |
Fax Number: | |
NPI Enumeration Date: | 04/01/2015 |
NPI Last Update Date: | 04/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 302794 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |