Provider Demographics
NPI:1255925483
Name:BRILLON, JOSEPH SAMUEL (MA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:BRILLON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:SAMUEL
Other - Last Name:BRILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6843 DEL NORTE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-2552
Mailing Address - Country:US
Mailing Address - Phone:281-761-4190
Mailing Address - Fax:
Practice Address - Street 1:718 W ARAPAHO RD STE 100A
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4160
Practice Address - Country:US
Practice Address - Phone:214-530-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health