Provider Demographics
NPI:1356924872
Name:FARRELL, BRANDEE MOULTON (MS, LPC-IT)
Entity type:Individual
Prefix:
First Name:BRANDEE
Middle Name:MOULTON
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1421 BROADWAY ST N STE 114B
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4728
Mailing Address - Country:US
Mailing Address - Phone:715-308-5742
Mailing Address - Fax:888-972-4831
Practice Address - Street 1:2005 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4455
Practice Address - Country:US
Practice Address - Phone:715-832-5454
Practice Address - Fax:715-832-2991
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional