MEDICARE: JANA BRULTZ LPC

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	0701003392	VA

General Provider Information

NPI Number	:	1700285723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA BRULTZ LPC

Provider Business Mailing Address
First Line	:	3908 ST MARYS CIR
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2422
Country	:	US
Telephone Number	:	804-787-0486
Fax Number	:	757-345-6808

Provider Business Practice Location Address
First Line	:	1769 JAMESTOWN RD STE 113
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2310
Country	:	US
Telephone Number	:	804-787-0496
Fax Number	:

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

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	03/28/2025

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