MEDICARE: MRS. BREANNE TERESA PASSALACQUA M.A.,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	6401225133	MI

General Provider Information

NPI Number	:	1275921629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BREANNE TERESA PASSALACQUA M.A.,LPC

Provider Business Mailing Address
First Line	:	10291 FOLEY RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-9250
Country	:	US
Telephone Number	:	810-597-7293
Fax Number	:

Provider Business Practice Location Address
First Line	:	10291 FOLEY RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-9250
Country	:	US
Telephone Number	:	810-597-7293
Fax Number	:

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

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	02/15/2026

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