MEDICARE: BREA GRUENEICH MS, NCC, LPC-MH, QMH

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-MH30501	SD

General Provider Information

NPI Number	:	1437791720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREA GRUENEICH MS, NCC, LPC-MH, QMH

Provider Business Mailing Address
First Line	:	4900 S MINNESOTA AVE STE 101
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2865
Country	:	US
Telephone Number	:	605-467-7424
Fax Number	:	605-309-7917

Provider Business Practice Location Address
First Line	:	4900 S MINNESOTA AVE STE 101
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2865
Country	:	US
Telephone Number	:	605-467-7424
Fax Number	:	605-309-7917

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	06/02/2023

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