MEDICARE: ALICIA BRIGHAM

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	70117	TX

General Provider Information

NPI Number	:	1881060200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALICIA BRIGHAM

Provider Business Mailing Address
First Line	:	17811 VAIL ST
Second Line	:	APT. 2309
City	:	DALLAS
State	:	TX
Zip	:	75287-6460
Country	:	US
Telephone Number	:	817-879-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 HUFFINES BLVD STE 121
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-6524
Country	:	US
Telephone Number	:	817-879-2215
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	ALICIA BRIGHAM
Credential	:	MA, LPC
Telephone Number	:	817-879-2215

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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Directions to “ALICIA BRIGHAM ” Practice Location

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