MEDICARE: ALISON SUZANNE BRENNAN LMHC

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	101YM0800X	Mental Health Counselor	00941	IA

General Provider Information

NPI Number	:	1245289271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON SUZANNE BRENNAN LMHC

Provider Business Mailing Address
First Line	:	201 E 11TH ST
Second Line	:
City	:	SPENCER
State	:	IA
Zip	:	51301-4436
Country	:	US
Telephone Number	:	712-262-2922
Fax Number	:	712-262-3826

Provider Business Practice Location Address
First Line	:	315 1ST AVE
Second Line	:	SUITE 202
City	:	ROCK RAPIDS
State	:	IA
Zip	:	51246-1543
Country	:	US
Telephone Number	:	712-472-9605
Fax Number	:	712-472-3587

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	06/25/2010

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