MEDICARE: BRIELLE LAKAY GILLIS MA

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	3747P1801X	Personal Care Attendant		TX

General Provider Information

NPI Number	:	1649093006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIELLE LAKAY GILLIS MA

Provider Business Mailing Address
First Line	:	3819 MENARD ST APT 1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-2656
Country	:	US
Telephone Number	:	337-240-6046
Fax Number	:

Provider Business Practice Location Address
First Line	:	3819 MENARD ST APT 1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-2656
Country	:	US
Telephone Number	:	337-240-6046
Fax Number	:

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

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/26/2024

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Directions to “ BRIELLE LAKAY GILLIS MA” Practice Location

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