Healthcare Provider Details

I. General information

NPI: 1093601684
Provider Name (Legal Business Name): BREANNA HEANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W PINNACLE PEAK RD STE 220
PHOENIX AZ
85027-1224
US

IV. Provider business mailing address

2222 W PINNACLE PEAK RD STE 220
PHOENIX AZ
85027-1224
US

V. Phone/Fax

Practice location:
  • Phone: 480-454-6383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC24661
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: