Doctor Name: | MRS. BREANNA DEE HERBST |
NPI Number: | 1477795615 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., L.P.C.C. |
License Number: | LPCC000556 |
Business Practice Address: | 1068 Lake St S Suite 12 Forest Lake, MN - 550252639 |
Business Phone Number: | 6514642194 |
Business Fax Number: | |
Mailing Address: | 35624 Lincoln Rd, NORTH BRANCH |
State: | MN |
Postal Code: | 550565789 |
Phone Number: | 6512746674 |
Fax Number: | |
NPI Enumeration Date: | 04/02/2009 |
NPI Last Update Date: | 07/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPCC000556 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |