Provider Demographics
NPI:1639586639
Name:BRENNEMAN, ALLISON (MA LMFT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:907 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1508
Mailing Address - Country:US
Mailing Address - Phone:763-274-0510
Mailing Address - Fax:763-441-3117
Practice Address - Street 1:907 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1508
Practice Address - Country:US
Practice Address - Phone:763-274-0510
Practice Address - Fax:763-441-3117
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist