Provider Demographics
NPI:1033493374
Name:ELKINS, BRIONNE
Entity Type:Individual
Prefix:
First Name:BRIONNE
Middle Name:
Last Name:ELKINS
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:PO BOX 650859
Mailing Address - Street 2:DEPT 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-3443
Mailing Address - Country:US
Mailing Address - Phone:409-747-6240
Mailing Address - Fax:907-561-3315
Practice Address - Street 1:250 BLOSSOM ST FL 4
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:832-632-7999
Practice Address - Fax:907-561-3315
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39434103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG736Medicaid