Provider Demographics
NPI:1386285716
Name:WEITZEL, BREANNA JOY (MA, LPCC)
Entity type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:JOY
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 UNIVERSITY AVE W STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1854
Mailing Address - Country:US
Mailing Address - Phone:651-644-4100
Mailing Address - Fax:651-644-4885
Practice Address - Street 1:2324 UNIVERSITY AVE W STE 120
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1854
Practice Address - Country:US
Practice Address - Phone:651-644-4100
Practice Address - Fax:651-644-4885
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional