=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558860551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIYON MINOR LAPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2018
-----------------------------------------------------
Last Update Date | 02/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1910 OAKLEAF LN
-----------------------------------------------------
City | LITHIA SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30122-2784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-334-9033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1910 OAKLEAF LN
-----------------------------------------------------
City | LITHIA SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30122-2784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-334-9033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------