Healthcare Provider Details

I. General information

NPI: 1457936510
Provider Name (Legal Business Name): BREANNA BALDWIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 STARLYN AVE
NEW ALBANY MS
38652-2428
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 662-486-5122
  • Fax: 662-486-5123
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3427
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: