Basic Information
| Provider Information | |||||||||
| NPI: | 1376204263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIGGINS | ||||||||
| FirstName: | BREANNA | ||||||||
| MiddleName: | ANDREA | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | RMHCI | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 PARKER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334052507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616161222 | ||||||||
| FaxNumber: | 5616161230 | ||||||||
| Practice Location | |||||||||
| Address1: | 4101 PARKER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334052507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616161222 | ||||||||
| FaxNumber: | 5616161230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2022 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMH21664 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.