Healthcare Provider Details

I. General information

NPI: 1356782759
Provider Name (Legal Business Name): DAVID E BRIGGS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2013
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 YOST AVE
PARK RIDGE IL
60068-5549
US

IV. Provider business mailing address

151 YOST AVE
PARK RIDGE IL
60068-5549
US

V. Phone/Fax

Practice location:
  • Phone: 847-696-7324
  • Fax:
Mailing address:
  • Phone: 847-696-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178007453
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: