MEDICARE: WILLIAM L BRISLIN LMHC

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	101YM0800X	Mental Health Counselor	MH4281	FL

General Provider Information

NPI Number	:	1821000175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM L BRISLIN LMHC

Provider Business Mailing Address
First Line	:	1417 N SEMORAN BLVD
Second Line	:	SUITE 201
City	:	ORLANDO
State	:	FL
Zip	:	32807-3555
Country	:	US
Telephone Number	:	407-384-3344
Fax Number	:	407-658-2200

Provider Business Practice Location Address
First Line	:	1417 N SEMORAN BLVD
Second Line	:	SUITE 201
City	:	ORLANDO
State	:	FL
Zip	:	32807-3555
Country	:	US
Telephone Number	:	407-384-3344
Fax Number	:	407-658-2200

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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