Provider Demographics
NPI:1134281678
Name:BRISCOE, JEANNETTE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:M
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OFFICE PARK CIR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2510
Mailing Address - Country:US
Mailing Address - Phone:205-912-2000
Mailing Address - Fax:205-945-1890
Practice Address - Street 1:3 OFFICE PARK CIR
Practice Address - Street 2:SUITE 115
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2510
Practice Address - Country:US
Practice Address - Phone:205-912-2000
Practice Address - Fax:205-945-1890
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0574C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL06160574COtherPIP
AL680638098OtherOTHER
AL012160OtherVALUE OPTIONS
AL459564000OtherMAGELLAN
AL51534635OtherAMERICAN BEHAVIORAL
AL612133200OtherOWCP
AL06160574COtherPIP