Provider Demographics
NPI:1851252985
Name:BRAZIL, LORI (MMFC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BRAZIL
Suffix:
Gender:F
Credentials:MMFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 BRENTWOOD PT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7911
Mailing Address - Country:US
Mailing Address - Phone:615-293-1737
Mailing Address - Fax:
Practice Address - Street 1:5200 MARYLAND WAY STE 102
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5072
Practice Address - Country:US
Practice Address - Phone:615-861-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2791106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist