Provider Demographics
NPI:1174174908
Name:DR BRECKE COUNSELING GROUP
Entity type:Organization
Organization Name:DR BRECKE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMFT LPCC
Authorized Official - Phone:651-206-5783
Mailing Address - Street 1:3698 WINDTREE DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1318
Mailing Address - Country:US
Mailing Address - Phone:651-235-8751
Mailing Address - Fax:
Practice Address - Street 1:1185 TOWN CENTRE DR STE 245
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1187
Practice Address - Country:US
Practice Address - Phone:651-206-5783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty