Healthcare Provider Details

I. General information

NPI: 1730877259
Provider Name (Legal Business Name): ANSELMO BRILLON JR. LPCC 13752
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W LEXINGTON AVE UNIT 603
EL CAJON CA
92022-5225
US

IV. Provider business mailing address

PO BOX 603
EL CAJON CA
92022-0603
US

V. Phone/Fax

Practice location:
  • Phone: 619-693-8538
  • Fax:
Mailing address:
  • Phone: 619-693-8538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: