Provider Demographics
NPI:1518719608
Name:CLENNON, BRIEANA
Entity Type:Individual
Prefix:
First Name:BRIEANA
Middle Name:
Last Name:CLENNON
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:PO BOX 120786
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0786
Mailing Address - Country:US
Mailing Address - Phone:352-200-2483
Mailing Address - Fax:
Practice Address - Street 1:1155 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2341
Practice Address - Country:US
Practice Address - Phone:407-594-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health