Provider Demographics
NPI:1386530483
Name:GOURLEY, BRIELLE ALEXIS (LGPC)
Entity type:Individual
Prefix:
First Name:BRIELLE
Middle Name:ALEXIS
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WARNERS TER N UNIT 207
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8771
Mailing Address - Country:US
Mailing Address - Phone:443-764-7489
Mailing Address - Fax:
Practice Address - Street 1:3100F MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2018
Practice Address - Country:US
Practice Address - Phone:410-841-9647
Practice Address - Fax:888-636-5301
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional