Provider Demographics
NPI:1194351346
Name:GILLEASE, BREANNE (LPC)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:GILLEASE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 OLD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1024
Mailing Address - Country:US
Mailing Address - Phone:484-955-4875
Mailing Address - Fax:
Practice Address - Street 1:1201 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3415
Practice Address - Country:US
Practice Address - Phone:610-279-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional