Provider Demographics
NPI:1831574672
Name:BRUNELLO, LAURI ANN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:ANN
Last Name:BRUNELLO
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:LAURI
Other - Middle Name:ANN
Other - Last Name:WEICKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:3503 HIGHPOINT DR N STE 230
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-7577
Mailing Address - Country:US
Mailing Address - Phone:612-440-2939
Mailing Address - Fax:
Practice Address - Street 1:3503 HIGHPOINT DR N STE 230
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-7577
Practice Address - Country:US
Practice Address - Phone:612-440-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303789101YA0400X
MNCC00583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)