Provider Demographics
NPI:1134933955
Name:BRIANNE, ALIYA (LPC-IT)
Entity type:Individual
Prefix:
First Name:ALIYA
Middle Name:
Last Name:BRIANNE
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 JENSEN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:WI
Mailing Address - Zip Code:54411-9338
Mailing Address - Country:US
Mailing Address - Phone:715-348-0974
Mailing Address - Fax:
Practice Address - Street 1:227400 RIB MOUNTAIN DR STE D
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5049
Practice Address - Country:US
Practice Address - Phone:715-301-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8290-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional