Provider Demographics
NPI:1346868882
Name:KOCON, BRIANNA (LPCC, LMHC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:KOCON
Suffix:
Gender:F
Credentials:LPCC, LMHC
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:BRUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, LMHC
Mailing Address - Street 1:1605 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3124
Mailing Address - Country:US
Mailing Address - Phone:575-527-0614
Mailing Address - Fax:575-541-4062
Practice Address - Street 1:1605 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3124
Practice Address - Country:US
Practice Address - Phone:575-527-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0214401101YM0800X
MN2528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty