Provider Demographics
NPI:1437791720
Name:GRUENEICH, BREA (MS, NCC, LPC-MH, QMH)
Entity Type:Individual
Prefix:
First Name:BREA
Middle Name:
Last Name:GRUENEICH
Suffix:
Gender:F
Credentials:MS, NCC, LPC-MH, QMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MINNESOTA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2865
Mailing Address - Country:US
Mailing Address - Phone:605-467-7424
Mailing Address - Fax:605-309-7917
Practice Address - Street 1:4900 S MINNESOTA AVE STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2865
Practice Address - Country:US
Practice Address - Phone:605-467-7424
Practice Address - Fax:605-309-7917
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH30501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty