Healthcare Provider Details

I. General information

NPI: 1497275648
Provider Name (Legal Business Name): BRIANA JURREMA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 VIP DR STE 310
WEXFORD PA
15090-6936
US

IV. Provider business mailing address

510 CARVINE CT
WEXFORD PA
15090-7662
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-3905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC012664
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: