Provider Demographics
NPI:1548494651
Name:HURLBERT, BREANNE DANIELLE (LPC MACP)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:DANIELLE
Last Name:HURLBERT
Suffix:
Gender:F
Credentials:LPC MACP
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:DANIELLE
Other - Last Name:FUELLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC MACP
Mailing Address - Street 1:550 E WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 E WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2228
Practice Address - Country:US
Practice Address - Phone:630-292-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional