Healthcare Provider Details

I. General information

NPI: 1992076061
Provider Name (Legal Business Name): DEBORAH MARIE BRISEBOIS LCSW, LMHP, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2012
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 VALLEY CREEK DR STE I
ELGIN IL
60123-2694
US

IV. Provider business mailing address

936 APPALOOSA CT
SLEEPY HOLLOW IL
60118-2517
US

V. Phone/Fax

Practice location:
  • Phone: 847-687-4361
  • Fax:
Mailing address:
  • Phone: 847-687-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.016361
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: