Provider Demographics
NPI:1831492016
Name:PAQUETTE, BREANNA (MS, LPC, LADC)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:MS, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 CINNAMON TEAL DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3348
Mailing Address - Country:US
Mailing Address - Phone:405-317-1736
Mailing Address - Fax:
Practice Address - Street 1:1700 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1312
Practice Address - Country:US
Practice Address - Phone:405-317-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4460101YP2500X, 101YM0800X
OK1007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health