Provider Demographics
NPI:1609172014
Name:BRISBINE, TRICIA KATHERINE
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:KATHERINE
Last Name:BRISBINE
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 1:815 CALIFORNIA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-3457
Mailing Address - Country:US
Mailing Address - Phone:651-224-3695
Mailing Address - Fax:
Practice Address - Street 1:815 CALIFORNIA AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-3457
Practice Address - Country:US
Practice Address - Phone:651-224-3695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health