Michael James Brissett, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

000558 Issued in GA

Practice address

620 Hillcrest Rd NW
Suite 300
Lilburn, GA 30047-1709

Phone

(770) 638-1577

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gracepoint Counseling Associates

  • Clinical Psychologist
  • Lilburn, GA
  • NPI 1487705091
  NPD (past) Authorized official

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342569600000",
    "number": "1407914773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 HILLCREST RD NW",
            "address_2": "SUITE 300",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471709",
            "telephone_number": "770-638-1577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 HILLCREST RD NW",
            "address_2": "SUITE 300",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471709",
            "telephone_number": "770-638-1577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISSETT",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2012-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "000558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00494205C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Palmer Branch, D.P.M
• William George Brandenburg, DDS
• Braveheart Medical Response LLC
• Karen Bridges, RPH
• Rebecca L Brigola, APNP
• Alan D Brown Jr., O.D.
• Roselyn Burton Brown, PA-C
• Erin Bullock
• Melissa Renae Burgess, CPM
• Marisa Burnham

• Clinical Psychologist in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.