Provider Demographics
NPI:1417522822
Name:STONE, BREANN LEIGH
Entity Type:Individual
Prefix:
First Name:BREANN
Middle Name:LEIGH
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 S BOLTON RD
Mailing Address - Street 2:
Mailing Address - City:POSEN
Mailing Address - State:MI
Mailing Address - Zip Code:49776-9603
Mailing Address - Country:US
Mailing Address - Phone:989-255-0196
Mailing Address - Fax:
Practice Address - Street 1:5039 VILLA LINDE PKWY STE 30
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3450
Practice Address - Country:US
Practice Address - Phone:989-401-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty