MEDICARE: ALEXIS BRENNECKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1164853214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS BRENNECKE

Provider Business Mailing Address
First Line	:	2534 AIRPORT RD
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-1113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 E SEVENTH ST STE 3
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-5236
Country	:	US
Telephone Number	:	775-841-6050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/27/2013

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Directions to “ ALEXIS BRENNECKE ” Practice Location

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