Provider Demographics
NPI:1073679122
Name:BRISLAIN, JUDY ANN (EDD LMFT)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:ANN
Last Name:BRISLAIN
Suffix:
Gender:F
Credentials:EDD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 CEANOTHUS AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7611
Mailing Address - Country:US
Mailing Address - Phone:530-342-2567
Mailing Address - Fax:530-342-2573
Practice Address - Street 1:2545 CEANOTHUS AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7611
Practice Address - Country:US
Practice Address - Phone:530-342-2567
Practice Address - Fax:530-342-2573
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 15138101YP2500X
CALEP1500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist