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NPI Code Detail

MEDICARE: BREANNA FANNING

MEDICARE: BREANNA FANNING
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1306457189
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA FANNING
Provider Business Mailing Address
First Line : 18417 SE OAK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97233-4850
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18417 SE OAK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97233-4850
Country : US
Telephone Number : 971-727-8026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 08/13/2020

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Directions to “ BREANNA FANNING ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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