Provider Demographics
NPI:1578237913
Name:PERKINS, BRINYEL M (LCPC)
Entity Type:Individual
Prefix:
First Name:BRINYEL
Middle Name:M
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21720 W LONG GROVE RD STE C
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3752
Mailing Address - Country:US
Mailing Address - Phone:708-872-7328
Mailing Address - Fax:
Practice Address - Street 1:4606B W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4719
Practice Address - Country:US
Practice Address - Phone:708-872-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty