MEDICARE: BREANNA LYNN LPCC

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	14950	CA

General Provider Information

NPI Number	:	1689011793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA LYNN LPCC

Provider Business Mailing Address
First Line	:	6695 E PACIFIC COAST HWY STE 135
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4235
Country	:	US
Telephone Number	:	562-431-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6695 E PACIFIC COAST HWY STE 135
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4235
Country	:	US
Telephone Number	:	562-431-5100
Fax Number	:

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

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	10/26/2023

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