Doctor Name: | NICOLE ANDREA BRENNY |
NPI Number: | 1518208362 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC, LPCC |
License Number: | 201203 |
Business Practice Address: | 115 6th St Nw Cass Lake, MN - 566333428 |
Business Phone Number: | 2183353028 |
Business Fax Number: | |
Mailing Address: | 115 6th St Nw, CASS LAKE |
State: | MN |
Postal Code: | 566333428 |
Phone Number: | 2183353028 |
Fax Number: | |
NPI Enumeration Date: | 03/04/2013 |
NPI Last Update Date: | 03/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 201203 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |