Provider Demographics
NPI:1205860350
Name:BRIETSTEIN, H ABRAHAM (LIC)
Entity Type:Individual
Prefix:DR
First Name:H ABRAHAM
Middle Name:
Last Name:BRIETSTEIN
Suffix:
Gender:M
Credentials:LIC
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 11423
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-1423
Mailing Address - Country:US
Mailing Address - Phone:865-584-6111
Mailing Address - Fax:865-584-6196
Practice Address - Street 1:4006 SUTHERLAND AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-584-6111
Practice Address - Fax:865-584-6196
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3682443Medicare ID - Type Unspecified