Healthcare Provider Details

I. General information

NPI: 1225337389
Provider Name (Legal Business Name): BRIANNA M ISON DSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S MCCLINTOCK DR SUITE 105
TEMPE AZ
85282-2692
US

IV. Provider business mailing address

1400 E SOUTHERN AVE STE. 735
TEMPE AZ
85282-5691
US

V. Phone/Fax

Practice location:
  • Phone: 480-804-0326
  • Fax: 480-804-0083
Mailing address:
  • Phone: 480-804-0326
  • Fax: 480-804-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-13242
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-14075
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: