Provider Demographics
NPI:1083274534
Name:SEUFFER, BREANA J (MA, LPC-IT, SAC-IT)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:J
Last Name:SEUFFER
Suffix:
Gender:F
Credentials:MA, LPC-IT, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:POY SIPPI
Mailing Address - State:WI
Mailing Address - Zip Code:54967-0386
Mailing Address - Country:US
Mailing Address - Phone:920-379-0009
Mailing Address - Fax:
Practice Address - Street 1:W2333 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:POY SIPPI
Practice Address - State:WI
Practice Address - Zip Code:54967-8108
Practice Address - Country:US
Practice Address - Phone:920-379-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8115-125101YP2500X
WI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100091871Medicaid