Provider Demographics
NPI:1578196440
Name:CHACON, BRIANNA MICHELE (LIMHP, LCSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MICHELE
Last Name:CHACON
Suffix:
Gender:F
Credentials:LIMHP, LCSW
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:MICHELE
Other - Last Name:ADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLMHP, PLCSW
Mailing Address - Street 1:4003 PONY EXPRESS RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2555
Mailing Address - Country:US
Mailing Address - Phone:402-806-2410
Mailing Address - Fax:
Practice Address - Street 1:3720 A AVE STE E
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8169
Practice Address - Country:US
Practice Address - Phone:308-234-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health