Provider Demographics
NPI:1275195919
Name:BRISSETT, WINNIE
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:
Last Name:BRISSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 HAMILTON LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4033
Mailing Address - Country:US
Mailing Address - Phone:702-900-1489
Mailing Address - Fax:
Practice Address - Street 1:2755 E DESERT INN RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3696
Practice Address - Country:US
Practice Address - Phone:702-550-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health