MEDICARE: BRENNA ALEXANDER LPC, LAAC

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	LASAC-15497	AZ
2	101YP2500X	Professional Counselor	LPC-23569	AZ

General Provider Information

NPI Number	:	1366207417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA ALEXANDER LPC, LAAC

Provider Business Mailing Address
First Line	:	4323 W OLIVE AVE # 105
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3825
Country	:	US
Telephone Number	:	602-456-4817
Fax Number	:

Provider Business Practice Location Address
First Line	:	4323 W OLIVE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3825
Country	:	US
Telephone Number	:	602-456-4817
Fax Number	:

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

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	07/09/2025

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