Healthcare Provider Details

I. General information

NPI: 1427720820
Provider Name (Legal Business Name): BRIANA SPIVEY BA, MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANA LEWIS

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N MAIN ST
ELIZABETHTOWN IL
62931-4463
US

IV. Provider business mailing address

PO BOX 759
GOLCONDA IL
62938-0759
US

V. Phone/Fax

Practice location:
  • Phone: 618-287-7010
  • Fax:
Mailing address:
  • Phone: 618-683-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: