Provider Demographics
NPI:1861429219
Name:DAVID BRINKMAN-SULL, INC.
Entity type:Organization
Organization Name:DAVID BRINKMAN-SULL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:BRINKMAN-SULL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-539-5452
Mailing Address - Street 1:18330 GEAUGA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-1515
Mailing Address - Country:US
Mailing Address - Phone:440-539-5452
Mailing Address - Fax:216-595-0118
Practice Address - Street 1:23210 CHAGRIN BLVD
Practice Address - Street 2:COMMERCE PARK ONE - SUITE 211
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5462
Practice Address - Country:US
Practice Address - Phone:440-539-5452
Practice Address - Fax:216-595-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5376103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty