Provider Demographics
NPI:1477795615
Name:HERBST, BREANNA DEE (MS, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:DEE
Last Name:HERBST
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35624 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5789
Mailing Address - Country:US
Mailing Address - Phone:651-274-6674
Mailing Address - Fax:
Practice Address - Street 1:1068 LAKE ST S
Practice Address - Street 2:SUITE 12
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2639
Practice Address - Country:US
Practice Address - Phone:651-464-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPCC000556101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health