Provider Demographics
NPI:1750491627
Name:BRISBINE, BEVERLY JOANN (LMHC, CMHS)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JOANN
Last Name:BRISBINE
Suffix:
Gender:F
Credentials:LMHC, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-8342
Mailing Address - Country:US
Mailing Address - Phone:360-387-9443
Mailing Address - Fax:
Practice Address - Street 1:2091 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8342
Practice Address - Country:US
Practice Address - Phone:360-387-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health