MEDICARE: BRENNA JOHNSON PPC

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	101YP2500X	Professional Counselor	LPC-2548	WY

General Provider Information

NPI Number	:	1255024030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA JOHNSON PPC

Provider Business Mailing Address
First Line	:	1928 COTTONWOOD DR
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-7305
Country	:	US
Telephone Number	:	907-529-1891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1928 COTTONWOOD DR
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-7305
Country	:	US
Telephone Number	:	907-529-1891
Fax Number	:

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

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	04/14/2026

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Directions to “ BRENNA JOHNSON PPC” Practice Location

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