Healthcare Provider Details

I. General information

NPI: 1669388203
Provider Name (Legal Business Name): BREANNA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 W MCCARTY ST
JEFFERSON CITY MO
65101-1544
US

IV. Provider business mailing address

1016 WINSTON DR
JEFFERSON CITY MO
65101-3648
US

V. Phone/Fax

Practice location:
  • Phone: 573-200-6197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025036582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: