1548494651 NPI number — BREANNE DANIELLE HURLBERT LPC MACP

Table of content: BREANNE DANIELLE HURLBERT LPC MACP (NPI 1548494651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548494651 NPI number — BREANNE DANIELLE HURLBERT LPC MACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURLBERT
Provider First Name:
BREANNE
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC MACP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUELLING
Provider Other First Name:
BREANNE
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC MACP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548494651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 E WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WEST CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60185-2228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WEST CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60185-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-292-8006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  178.005172 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com