MEDICARE: BREANNA PAQUETTE M.S., LPC, LADC

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	4460	OK
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1007	OK
3	101YM0800X	Mental Health Counselor	4460	OK

General Provider Information

NPI Number	:	1831492016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA PAQUETTE M.S., LPC, LADC

Provider Business Mailing Address
First Line	:	8201 CINNAMON TEAL DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3348
Country	:	US
Telephone Number	:	405-317-1736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W BRITTON RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-1312
Country	:	US
Telephone Number	:	405-317-1736
Fax Number	:

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

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	02/07/2013

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