MEDICARE: BRIANA Y PEREZ LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	27776	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	14963	TX

General Provider Information

NPI Number	:	1154848778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA Y PEREZ LCDC

Provider Business Mailing Address
First Line	:	1430 COLLIER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2911
Country	:	US
Telephone Number	:	512-472-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 RIDGE OAK RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1914
Country	:	US
Telephone Number	:	512-599-8177
Fax Number	:

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

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	09/11/2019

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