Doctor Name: | MS. LAURA A BRENKE |
NPI Number: | 1063771269 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180.008142 |
Business Practice Address: | 1608 W Colonial Pkwy Ste 203 Inverness, IL - 600674755 |
Business Phone Number: | 2245200189 |
Business Fax Number: | |
Mailing Address: | 1640 Rockport Rd, HAMPSHIRE |
State: | IL |
Postal Code: | 601409062 |
Phone Number: | 2245200189 |
Fax Number: | |
NPI Enumeration Date: | 05/08/2012 |
NPI Last Update Date: | 11/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 180.008142 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |