Provider Demographics
NPI:1215257332
Name:BRUEGGEMANN, MARIANE BEFFA (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:MARIANE
Middle Name:BEFFA
Last Name:BRUEGGEMANN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4723 HIGHWAY 185
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-2624
Mailing Address - Country:US
Mailing Address - Phone:573-459-6685
Mailing Address - Fax:
Practice Address - Street 1:4723 HIGHWAY 185
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-2624
Practice Address - Country:US
Practice Address - Phone:573-459-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007012435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional