Provider Demographics
NPI:1881245991
Name:KLINE, BREANNE LYNN (MA)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:LYNN
Last Name:KLINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
Mailing Address - Street 2:MSC09-5030
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-2237
Mailing Address - Fax:505-272-4921
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
Practice Address - Street 2:MSC09-5030, UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2237
Practice Address - Fax:505-272-4921
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106S00000X, 390200000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician