Tia Brisco, Licensed Marriage and Family Therapy, Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

TIA BRISCO, LICENSED MARRIAGE AND FAMILY THERAPY, INC.

Practice address

17130 Devonshire St Ste 104a
Northridge, CA 91325-1676

Phone

(661) 675-8756

NPI assigned

Jan 16, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tia Brisco, LMFT

Title

Owner

Phone

(661) 675-8756

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587772800000",
    "number": "1043840192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17130 DEVONSHIRE ST STE 104A",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251676",
            "telephone_number": "661-675-8756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17130 DEVONSHIRE ST STE 104A",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251676",
            "telephone_number": "661-675-8756"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 Sierra Ct Ste 326",
            "address_purpose": "LOCATION",
            "city": "Palmdale",
            "state": "CA",
            "postal_code": "935507619",
            "country_code": "US",
            "telephone_number": "661-675-8756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIA BRISCO, LICENSED MARRIAGE AND FAMILY THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-16",
        "last_updated": "2020-04-25",
        "certification_date": "2020-04-25",
        "status": "A",
        "authorized_official_last_name": "BRISCO",
        "authorized_official_first_name": "TIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "661-675-8756",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Northridge, CA
• Providers in Northridge, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.