Provider Demographics
NPI:1235941642
Name:BRICHETTO, BRIEANNA
Entity type:Individual
Prefix:
First Name:BRIEANNA
Middle Name:
Last Name:BRICHETTO
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 1:5332 DOVE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4569
Mailing Address - Country:US
Mailing Address - Phone:682-429-5625
Mailing Address - Fax:
Practice Address - Street 1:4917 GOLDEN TRIANGLE BLVD STE 421
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4673
Practice Address - Country:US
Practice Address - Phone:817-754-4938
Practice Address - Fax:817-717-8584
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-382216106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician