Provider Demographics
NPI:1275001414
Name:EAGLETON, BRIANA ALEXUS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:ALEXUS
Last Name:EAGLETON
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 1:4625 LILLIAN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5544
Mailing Address - Country:US
Mailing Address - Phone:713-861-4849
Mailing Address - Fax:713-867-4021
Practice Address - Street 1:4625 LILLIAN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5544
Practice Address - Country:US
Practice Address - Phone:713-861-4849
Practice Address - Fax:713-867-4021
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX626551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical