Provider Demographics
NPI:1134753353
Name:VENABLE, BRIANA L (LCPC)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:L
Last Name:VENABLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:L
Other - Last Name:ROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3132 OLD JACKSONVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7401
Practice Address - Country:US
Practice Address - Phone:217-862-0800
Practice Address - Fax:217-862-0871
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.011173OtherLCPC LICENSE