Provider Demographics
NPI:1144952250
Name:BRISON, BRENDA (MED, TCM, TCADC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BRISON
Suffix:
Gender:F
Credentials:MED, TCM, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 CORINTH CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-7912
Mailing Address - Country:US
Mailing Address - Phone:606-515-2855
Mailing Address - Fax:
Practice Address - Street 1:73 THOMPSON POYNTER RD STE A
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7202
Practice Address - Country:US
Practice Address - Phone:606-687-5912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
KY247787101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator