MEDICARE: JENNIFER ANN BRANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13303	PA
2	101YM0800X	Mental Health Counselor	PC018234	PA

General Provider Information

NPI Number	:	1114859378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANN BRANT

Provider Business Mailing Address
First Line	:	115 S CENTRE ST STE 101
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-3076
Country	:	US
Telephone Number	:	570-622-1025
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 S CENTRE ST STE 101
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-3076
Country	:	US
Telephone Number	:	570-622-1025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ JENNIFER ANN BRANT ” Practice Location

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