Healthcare Provider Details

I. General information

NPI: 1558860551
Provider Name (Legal Business Name): BRIYON MINOR LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. BRIYON MINOR

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 OAKLEAF LN
LITHIA SPRINGS GA
30122-2784
US

IV. Provider business mailing address

1910 OAKLEAF LN
LITHIA SPRINGS GA
30122-2784
US

V. Phone/Fax

Practice location:
  • Phone: 678-334-9033
  • Fax:
Mailing address:
  • Phone: 678-334-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: