Provider Demographics
NPI:1609138239
Name:DAUGHERTY, BRIEANNA PATRICE (LPC)
Entity type:Individual
Prefix:MRS
First Name:BRIEANNA
Middle Name:PATRICE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:BRIEANNA
Other - Middle Name:PATRICE
Other - Last Name:GESINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15280 S 4TH ST
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-9473
Practice Address - Country:US
Practice Address - Phone:269-371-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012984101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1708146Medicaid