Provider Demographics
NPI:1467628453
Name:BRENNAN, JOHN MICHAEL (LSC, LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:LSC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 WOODBURY XING
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9433
Mailing Address - Country:US
Mailing Address - Phone:651-739-1128
Mailing Address - Fax:651-731-6345
Practice Address - Street 1:8490 WOODBURY XING
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9433
Practice Address - Country:US
Practice Address - Phone:651-739-1128
Practice Address - Fax:651-731-6345
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00597101YP2500X
MN416809101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool