Healthcare Provider Details

I. General information

NPI: 1548494651
Provider Name (Legal Business Name): BREANNE DANIELLE HURLBERT LPC MACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNE DANIELLE FUELLING LPC MACP

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON ST SUITE A
WEST CHICAGO IL
60185-2228
US

IV. Provider business mailing address

550 E WASHINGTON ST SUITE A
WEST CHICAGO IL
60185-2228
US

V. Phone/Fax

Practice location:
  • Phone: 630-292-8006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.005172
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: