Provider Demographics
NPI:1326371147
Name:BRECKE, KRISTY LYNNE (LPCC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNNE
Last Name:BRECKE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:LYNNE
Other - Last Name:BORDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2130 CLIFF RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2487
Mailing Address - Country:US
Mailing Address - Phone:651-206-5783
Mailing Address - Fax:
Practice Address - Street 1:2130 CLIFF RD STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2487
Practice Address - Country:US
Practice Address - Phone:651-206-5783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00011101YP2500X, 103TC1900X
MNCC00011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional