Provider Demographics
NPI:1487970844
Name:BRISCOE, BRIAN DOUGLAS (MS, LPC-I, LCDC-I)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:MS, LPC-I, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 MEADOW PARK CIR APT 157A
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-7718
Mailing Address - Country:US
Mailing Address - Phone:817-907-6937
Mailing Address - Fax:
Practice Address - Street 1:2428 MEADOW PARK CIR APT 157A
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-7718
Practice Address - Country:US
Practice Address - Phone:817-907-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64576101Y00000X
TX8222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)