MEDICARE: BRENNA MARIE VALSTED

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

General Provider Information

NPI Number	:	1548103849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA MARIE VALSTED

Provider Business Mailing Address
First Line	:	10715 VINE HILL DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-1297
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 BLEECKER ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-1457
Country	:	US
Telephone Number	:	917-831-5900
Fax Number	:

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

Provider Enumeration Date	:	04/11/2026
Last Update Date	:	04/11/2026

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Directions to “ BRENNA MARIE VALSTED ” Practice Location

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