Provider Demographics
NPI:1134509581
Name:BRILL, MICHAEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BRILL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 119TH CT NE UNIT B
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5060
Mailing Address - Country:US
Mailing Address - Phone:651-208-6998
Mailing Address - Fax:
Practice Address - Street 1:700 NE MULTNOMAH ST
Practice Address - Street 2:STE 275
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2131
Practice Address - Country:US
Practice Address - Phone:503-729-1380
Practice Address - Fax:503-841-6343
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3993103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling