1700409869 NPI number — BREANNE HALL STANERT M.ED., LMHC, LPC

Table of content: BREANNE HALL STANERT M.ED., LMHC, LPC (NPI 1700409869)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700409869 NPI number — BREANNE HALL STANERT M.ED., LMHC, LPC

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
STANERT

Provider First Name:
BREANNE

Provider Middle Name:
HALL

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
M.ED., LMHC, LPC

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
HALL

Provider Other First Name:
BREANNE

Provider Other Middle Name:
LEAH

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700409869

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
05/24/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7957 SILVER MAPLE DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
MILTON

Provider Business Mailing Address State Name:
FL

Provider Business Mailing Address Postal Code:
32583-2826

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:
358 STILES AVE # B

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
ORANGE PARK

Provider Business Practice Location Address State Name:
FL

Provider Business Practice Location Address Postal Code:
32073-4012

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
904-264-8311

Provider Business Practice Location Address Fax Number:
904-264-8377

Provider Enumeration Date:
05/24/2020

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: 101Y00000X , with the licence number: 007887 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 101Y00000X , with the licence number: 17550 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .