=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962192534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRI'S COUNSELING CORNER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2023
-----------------------------------------------------
Last Update Date | 05/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5210 S ORANGE AVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32809-3052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 762-233-8858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1719 COLLEEN DR
-----------------------------------------------------
City | BELLE ISLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32809-6874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 762-233-8858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIANNA EDWARDS
-----------------------------------------------------
Credential | LMHC, RPT
-----------------------------------------------------
Telephone | 762-233-8858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------