Healthcare Provider Details

I. General information

NPI: 1972741163
Provider Name (Legal Business Name): BREANNE HEALEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 S VAL VISTA DR
GILBERT AZ
85297-7000
US

IV. Provider business mailing address

3285 S VAL VISTA DR
GILBERT AZ
85297-7000
US

V. Phone/Fax

Practice location:
  • Phone: 480-397-2800
  • Fax:
Mailing address:
  • Phone: 803-972-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number62808
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001187
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1069
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: