Provider Demographics
NPI:1427720820
Name:SPIVEY, BRIANA (BA, MHP)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:BA, MHP
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:GOLCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:62938-0759
Mailing Address - Country:US
Mailing Address - Phone:618-683-2461
Mailing Address - Fax:
Practice Address - Street 1:147 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:IL
Practice Address - Zip Code:62931-4463
Practice Address - Country:US
Practice Address - Phone:618-287-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health