Provider Demographics
NPI:1255039699
Name:BREAUX, GINA (LPC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BREAUX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 N WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3949
Mailing Address - Country:US
Mailing Address - Phone:325-513-2510
Mailing Address - Fax:
Practice Address - Street 1:6400 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3860
Practice Address - Country:US
Practice Address - Phone:520-600-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional