Provider Demographics
NPI:1558026906
Name:BRIXEY, BLAINE MICHAEL (LMFT-I)
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:MICHAEL
Last Name:BRIXEY
Suffix:
Gender:M
Credentials:LMFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 BOULDER FALLS ST APT 2049
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4963
Mailing Address - Country:US
Mailing Address - Phone:702-815-5933
Mailing Address - Fax:
Practice Address - Street 1:7310 SMOKE RANCH RD
Practice Address - Street 2:S
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0258
Practice Address - Country:US
Practice Address - Phone:702-456-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI3218106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist