| Tia Brisco, Licensed Marriage And Family Therapy, Inc. | |
|
17130 Devonshire St Ste 104a Northridge CA 91325-1676 | |
| (661) 675-8756 | |
| Not Available |
| Full Name | Tia Brisco, Licensed Marriage And Family Therapy, Inc. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 17130 Devonshire St Ste 104a, Northridge, California |
| Authorized Official Name and Position | Tia Brisco (OWNER) |
| Authorized Official Contact | 6616758756 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tia Brisco, Licensed Marriage And Family Therapy, Inc. 17130 Devonshire St Ste 104a Northridge CA 91325-1676 Ph: (661) 675-8756 | Tia Brisco, Licensed Marriage And Family Therapy, Inc. 17130 Devonshire St Ste 104a Northridge CA 91325-1676 Ph: (661) 675-8756 |
| NPI Number | 1043840192 |
|---|---|
| Provider Enumeration Date | 01/16/2020 |
| Last Update Date | 04/25/2020 |
| Certification Date | 04/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043840192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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