Provider Demographics
NPI:1750126223
Name:BRINCHFIELD, SHADAI LANIE
Entity type:Individual
Prefix:
First Name:SHADAI
Middle Name:LANIE
Last Name:BRINCHFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4471
Mailing Address - Country:US
Mailing Address - Phone:469-285-4529
Mailing Address - Fax:
Practice Address - Street 1:340 DAKOTA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4471
Practice Address - Country:US
Practice Address - Phone:469-285-4529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional