Individual
BRANDON MICHAEL TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
865 S PATTERSON BLVD, DAYTON, OH 45402-2624
(937) 966-4673
Mailing address
100 CROWNE POINT PL, CINCINNATI, OH 45241-5427
(513) 743-7628
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.2411331
OH
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
10/25/2021
Last updated
08/19/2024
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