Healthcare Provider Details

I. General information

NPI: 1134908726
Provider Name (Legal Business Name): BREANNA J KAFENTZIS MA, LMHC, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 STILLWELL CT
PROSPER TX
75078-3395
US

IV. Provider business mailing address

100 N HOWARD ST STE 4000
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 509-416-6424
  • Fax:
Mailing address:
  • Phone: 509-416-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.70045473
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number94871
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: