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General NPI Number Information
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NPI Number | 1801113162
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Entity Type | Individual
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Provider Name | BRILEY ELIZABETH PROCTOR PHD
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Gender | Female
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 2898 MAHAN DR SUITE 5
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5463
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Country | US
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Telephone | 850-552-0691
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Fax |
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Provider Business Mailing Address
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Address Line | 2327 ARMISTEAD RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-0905
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Country | US
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Telephone | 850-321-4499
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 6963
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License Number State | FL
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