Provider Demographics
NPI:1902437569
Name:NTOH, BRISLY
Entity Type:Individual
Prefix:
First Name:BRISLY
Middle Name:
Last Name:NTOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 E OLD SETTLERS BLVD UNIT 44
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2478
Mailing Address - Country:US
Mailing Address - Phone:213-820-1932
Mailing Address - Fax:
Practice Address - Street 1:2950 E OLD SETTLERS BLVD UNIT 44
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2478
Practice Address - Country:US
Practice Address - Phone:213-820-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty