Provider Demographics
NPI:1063172088
Name:OUELLETTE, BRIAN ANDREW I (LPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANDREW
Last Name:OUELLETTE
Suffix:I
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S SOLAIRA ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8092
Mailing Address - Country:US
Mailing Address - Phone:417-413-9266
Mailing Address - Fax:
Practice Address - Street 1:1215 S SOLAIRA ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8092
Practice Address - Country:US
Practice Address - Phone:417-413-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012014248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty