Provider Demographics
NPI:1588958714
Name:BRENNO, KRISTA RENEE (MA, LPC, LADC)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:RENEE
Last Name:BRENNO
Suffix:
Gender:F
Credentials:MA, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11191 ABERDEEN ST NE UNIT D
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6027
Mailing Address - Country:US
Mailing Address - Phone:651-983-4616
Mailing Address - Fax:
Practice Address - Street 1:11191 ABERDEEN ST NE UNIT D
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6027
Practice Address - Country:US
Practice Address - Phone:651-983-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302125101YA0400X
MN00727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health