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NPI 1366207417

NPI 1366207417 : BRENNA ALEXANDER LPC, LAAC : GLENDALE, AZ

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General NPI Number Information
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    NPI Number           |    1366207417
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    Entity Type          |    Individual 
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    Provider Name        |    BRENNA ALEXANDER LPC, LAAC
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    02/19/2024
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    Last Update Date     |    07/09/2025
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Provider Practice Location Address
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    Address Line         |    4323 W OLIVE AVE 
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    City                 |    GLENDALE
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    State                |    AZ
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    Zip                  |    85302-3825
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    Country              |    US
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    Telephone            |    602-456-4817
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    4323 W OLIVE AVE # 105 
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    City                 |    GLENDALE
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    State                |    AZ
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    Zip                  |    85302-3825
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    Country              |    US
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    Telephone            |    602-456-4817
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    101YA0400X
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    Taxonomy Name        |    Addiction (Substance Use Disorder) Counselor
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    License Number       |    LASAC-15497
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    License Number State |    AZ
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Taxonomy #2
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    Taxonomy Code        |    101YP2500X
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    Taxonomy Name        |    Professional Counselor
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    License Number       |    LPC-23569
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    License Number State |    AZ
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