MEDICARE: HALEY A BRENSDAL LPC

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	101YP2500X	Professional Counselor	LPC-3681	ID
2	101YP2500X	Professional Counselor	12190	MT

General Provider Information

NPI Number	:	1225196116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY A BRENSDAL LPC

Provider Business Mailing Address
First Line	:	1914 N SUMMERWIND PL
Second Line	:
City	:	KUNA
State	:	ID
Zip	:	83634-3463
Country	:	US
Telephone Number	:	208-922-9001
Fax Number	:	208-922-3778

Provider Business Practice Location Address
First Line	:	1411 MAIN ST STE B-C
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-1712
Country	:	US
Telephone Number	:	406-969-5183
Fax Number	:	406-281-8308

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	09/09/2020

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Directions to “ HALEY A BRENSDAL LPC” Practice Location

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