Active NPI
Nicole Renee Brisse
- Behavior Technician
- Troy, MI
National Provider Identifier
1437853702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 171M00000X
- Practice address
- 505 E Maple Rd
Troy, MI 48083-2806 - Phone
- (248) 918-5600
- NPI assigned
- Mar 29, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 171M00000X | MI | Primary |
Addresses
Primary practice location
505 E Maple Rd
Troy, MI 48083-2806
Mailing address
6540 Park Valley Dr
Clarkston, MI 48348-4552
Phone (248) 303-3030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 171M00000X | MI | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1437853702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6540 PARK VALLEY DR",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483484552",
"telephone_number": "248-303-3030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 E MAPLE RD",
"city": "TROY",
"state": "MI",
"postal_code": "480832806",
"telephone_number": "248-918-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISSE",
"first_name": "NICOLE",
"middle_name": "RENEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-29",
"last_updated": "2023-05-15",
"certification_date": "2023-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MI",
"license": "171M00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.