Healthcare Provider Details

I. General information

NPI: 1609138239
Provider Name (Legal Business Name): BRIEANNA PATRICE DAUGHERTY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. BRIEANNA PATRICE GESINSKI

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15280 S 4TH ST
SCHOOLCRAFT MI
49087-9473
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 269-371-4567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401012984
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401012984
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: