Provider Demographics
NPI:1972242071
Name:WRISTER, BRIA SYMONE
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:SYMONE
Last Name:WRISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14175 DALLAS PKWY APT 1379
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-4413
Mailing Address - Country:US
Mailing Address - Phone:901-674-3236
Mailing Address - Fax:
Practice Address - Street 1:4500 HILLCREST RD STE 135
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5421
Practice Address - Country:US
Practice Address - Phone:214-494-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12259495103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst