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General NPI Number Information
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NPI Number | 1831492016
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Entity Type | Individual
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Provider Name | BREANNA PAQUETTE M.S., LPC, LADC
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Gender | Female
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 1700 W BRITTON RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-1312
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Country | US
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Telephone | 405-317-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 8201 CINNAMON TEAL DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-3348
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Country | US
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Telephone | 405-317-1736
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4460
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1007
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4460
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License Number State | OK
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