Healthcare Provider Details

I. General information

NPI: 1639515372
Provider Name (Legal Business Name): LAINE LEANORA ESPINOZA BRIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAINE LEANORA BRIGGS

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 AMERICAS WAY
BOX ELDER SD
57719-7600
US

IV. Provider business mailing address

514 AMERICAS WAY
BOX ELDER SD
57719-7600
US

V. Phone/Fax

Practice location:
  • Phone: 208-201-8638
  • Fax:
Mailing address:
  • Phone: 208-201-8638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4927-R
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001711
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60819468
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: