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General NPI Number Information
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NPI Number | 1679109268
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Entity Type | Individual
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Provider Name | BRENDA RILEY LCDC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 711 S 11TH ST STE M
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City | RICHMOND
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State | TX
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Zip | 77469-3387
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Country | US
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Telephone | 409-658-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 2527 S 11TH ST
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City | NILES
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State | MI
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Zip | 49120-4747
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Country | US
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Telephone | 269-262-1815
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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