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General NPI Number Information
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NPI Number | 1881060200
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Entity Type | Organization
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Legal Business Name | ALICIA BRIGHAM
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 4020 HUFFINES BLVD STE 121
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City | CARROLLTON
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State | TX
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Zip | 75010-6524
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Country | US
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Telephone | 817-879-2215
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Fax |
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Provider Business Mailing Address
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Address Line | 17811 VAIL ST APT. 2309
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City | DALLAS
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State | TX
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Zip | 75287-6460
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Country | US
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Telephone | 817-879-2215
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | ALICIA BRIGHAM
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Credential | MA, LPC
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Telephone | 817-879-2215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 70117
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License Number State | TX
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