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General NPI Number Information
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NPI Number | 1174174908
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Entity Type | Organization
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Legal Business Name | DR BRECKE COUNSELING GROUP
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 1185 TOWN CENTRE DR STE 245
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City | EAGAN
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State | MN
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Zip | 55123-1187
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Country | US
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Telephone | 651-206-5783
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Fax |
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Provider Business Mailing Address
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Address Line | 3698 WINDTREE DR
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City | EAGAN
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State | MN
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Zip | 55123-1318
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Country | US
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Telephone | 651-235-8751
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | DR. KRISTY BRECKE
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Credential | DMFT LPCC
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Telephone | 651-206-5783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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