Provider Demographics
NPI:1134908726
Name:KAFENTZIS, BREANNA J (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:J
Last Name:KAFENTZIS
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 KENSINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7871
Mailing Address - Country:US
Mailing Address - Phone:509-438-7886
Mailing Address - Fax:
Practice Address - Street 1:1950 KEENE RD BLDG J
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7752
Practice Address - Country:US
Practice Address - Phone:509-416-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61466273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health