Provider Demographics
NPI:1184158966
Name:ALLEN, BRIANNA KATELYN (LPC, LPCC, CAADC)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:KATELYN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC, LPCC, CAADC
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:KATELYN
Other - Last Name:BEDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LPCC, CAADC
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:SWIFTWATER
Mailing Address - State:PA
Mailing Address - Zip Code:18370-0252
Mailing Address - Country:US
Mailing Address - Phone:570-588-8555
Mailing Address - Fax:570-902-7762
Practice Address - Street 1:300 CORNELL DR SE BLDG 73
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-7180
Practice Address - Country:US
Practice Address - Phone:505-277-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0355101YP2500X
PAPC008371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty