MEDICARE: MS. SHANNON BREHM 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	89198	TX

General Provider Information

NPI Number	:	1437971942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON BREHM LPC

Provider Business Mailing Address
First Line	:	1601 CANFIELD DR APT 1206
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-4922
Country	:	US
Telephone Number	:	757-236-1941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CANFIELD DR APT 1206
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-4922
Country	:	US
Telephone Number	:	757-236-1941
Fax Number	:

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

Provider Enumeration Date	:	10/26/2024
Last Update Date	:	10/26/2024

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