Healthcare Provider Details

I. General information

NPI: 1184158966
Provider Name (Legal Business Name): BRIANNA KATELYN ALLEN LPC, LPCC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIANNA KATELYN BEDARD LPC, LPCC, CAADC

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CORNELL DR SE BLDG 73
ALBUQUERQUE NM
87131-7180
US

IV. Provider business mailing address

PO BOX 252
SWIFTWATER PA
18370-0252
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax:
Mailing address:
  • Phone: 570-588-8555
  • Fax: 570-902-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2022-0355
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008371
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: