Basic Information
| Provider Information | |||||||||
| NPI: | 1598203119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRECI | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8451 E POINT DOUGLAS RD S | ||||||||
| Address2: | #30 | ||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550163331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514584116 | ||||||||
| FaxNumber: | 6514585632 | ||||||||
| Practice Location | |||||||||
| Address1: | 8451 E POINT DOUGLAS RD S | ||||||||
| Address2: | #30 | ||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550163331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514584116 | ||||||||
| FaxNumber: | 6514585632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2017 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 304392 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.