MEDICARE: GENELL BRENNA HOWELL MA, 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	101YM0800X	Mental Health Counselor	437	HI
2	101YM0800X	Mental Health Counselor	CTB-2022-0074	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CTB-2022-0074	OTHER	NM	LPCC
2	436	OTHER	HI	LMHC

General Provider Information

NPI Number	:	1871020800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENELL BRENNA HOWELL MA, LPCC

Provider Business Mailing Address
First Line	:	PO BOX 2288
Second Line	:
City	:	TAOS
State	:	NM
Zip	:	87571-2288
Country	:	US
Telephone Number	:	808-895-8451
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 EOTOTO RD
Second Line	:
City	:	EL PRADO
State	:	NM
Zip	:	87529-7423
Country	:	US
Telephone Number	:	808-895-8451
Fax Number	:

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

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	08/19/2024

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