Healthcare Provider Details

I. General information

NPI: 1346868882
Provider Name (Legal Business Name): BRIANNA KOCON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIANNA BRUSH LPCC, LMHC

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/21/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 FIELD ST
ROCHESTER NY
14620-1949
US

IV. Provider business mailing address

2864 MIDDLE ST STE 100
LITTLE CANADA MN
55117-1411
US

V. Phone/Fax

Practice location:
  • Phone: 763-218-3728
  • Fax:
Mailing address:
  • Phone: 763-218-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0214401
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2528
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: