MEDICARE: BREANNE HALL STANERT M.ED., LMHC, 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	101Y00000X	Counselor	007887	GA
2	101Y00000X	Counselor	17550	FL
3	101YM0800X	Mental Health Counselor	17550	FL

General Provider Information

NPI Number	:	1700409869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNE HALL STANERT M.ED., LMHC, LPC

Provider Business Mailing Address
First Line	:	2054 CREEKMONT DR
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-6874
Country	:	US
Telephone Number	:	912-687-1661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 TOWN CENTER BLVD
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-3356
Country	:	US
Telephone Number	:	904-649-5175
Fax Number	:	904-452-7854

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

Provider Enumeration Date	:	05/24/2020
Last Update Date	:	07/10/2025

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