=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043029101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BREANNE N LAMOUREAUX
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2025
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1211 MERRIAM ST
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99122-8654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-725-3001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 E HAWTHORNE AVE
-----------------------------------------------------
City | COLVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99114-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-684-4597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | CG61521182
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | CG61521182
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SC70000022
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------