MEDICARE: DR. JUDY ANN BRISLAIN ED.D. L.M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	MFT 15138	CA
2	103T00000X	Psychologist	LEP1500	CA

General Provider Information

NPI Number	:	1073679122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY ANN BRISLAIN ED.D. L.M.F.T.

Provider Business Mailing Address
First Line	:	2545 CEANOTHUS AVE
Second Line	:	SUITE 130
City	:	CHICO
State	:	CA
Zip	:	95973-7611
Country	:	US
Telephone Number	:	530-342-2567
Fax Number	:	530-342-2573

Provider Business Practice Location Address
First Line	:	2545 CEANOTHUS AVE
Second Line	:	SUITE 130
City	:	CHICO
State	:	CA
Zip	:	95973-7611
Country	:	US
Telephone Number	:	530-342-2567
Fax Number	:	530-342-2573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	09/11/2025

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