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NPI Code Detail

MEDICARE: TONYA RENEE BRISSEY LCSW, LAADC

MEDICARE: TONYA RENEE BRISSEY LCSW, LAADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker71047CA
2101YA0400XAddiction (Substance Use Disorder) Counselor03-061077CA

General Provider Information

NPI Number : 1053667881
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA RENEE BRISSEY LCSW, LAADC
Provider Business Mailing Address
First Line : 29632 E HIGHWAY 299
Second Line :
City : ROUND MOUNTAIN
State : CA
Zip : 96084-8000
Country : US
Telephone Number : 530-337-5750
Fax Number : 530-337-5793
Provider Business Practice Location Address
First Line : 29632 E HIGHWAY 299
Second Line :
City : ROUND MOUNTAIN
State : CA
Zip : 96084-8000
Country : US
Telephone Number : 530-337-5750
Fax Number : 530-337-5793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2012
Last Update Date : 02/24/2026

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