=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265028955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANYA BRIGNOLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2020
-----------------------------------------------------
Last Update Date | 02/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6263 POPLAR AVE STE 620
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38119-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-654-5551
-----------------------------------------------------
Fax | 901-651-5570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6263 POPLAR AVE STE 620
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38119-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-654-5551
-----------------------------------------------------
Fax | 901-651-5570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 5221
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------