Provider Demographics
NPI:1003527896
Name:KRAFFT-HARRIS, BREONNA V (LPC)
Entity Type:Individual
Prefix:
First Name:BREONNA
Middle Name:V
Last Name:KRAFFT-HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BREONNA
Other - Middle Name:V
Other - Last Name:KRAFFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:911 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4511
Mailing Address - Country:US
Mailing Address - Phone:208-371-9090
Mailing Address - Fax:
Practice Address - Street 1:911 11TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4511
Practice Address - Country:US
Practice Address - Phone:208-371-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6256101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health