Provider Demographics
NPI:1821118803
Name:BRIMLEY, KAREN (FP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BRIMLEY
Suffix:
Gender:F
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21015 N 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3462
Mailing Address - Country:US
Mailing Address - Phone:623-352-3489
Mailing Address - Fax:
Practice Address - Street 1:21015 N 82ND AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3462
Practice Address - Country:US
Practice Address - Phone:623-352-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ925050Medicaid