Provider Demographics
NPI:1114611720
Name:BRENNER, VICTORIA (MCOUN, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:MCOUN, LPC, NCC
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:LANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3676 N HARBOR LN #100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703
Mailing Address - Country:US
Mailing Address - Phone:208-629-2467
Mailing Address - Fax:208-615-9155
Practice Address - Street 1:3676 N HARBOR LN STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6919
Practice Address - Country:US
Practice Address - Phone:208-607-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional