Provider Demographics
NPI:1447081534
Name:LOPRESTO, BREANN (BS, BHT)
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:
Last Name:LOPRESTO
Suffix:
Gender:F
Credentials:BS, BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17505 N 79TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8724
Mailing Address - Country:US
Mailing Address - Phone:602-989-8899
Mailing Address - Fax:602-900-0969
Practice Address - Street 1:17505 N 79TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8724
Practice Address - Country:US
Practice Address - Phone:602-989-8899
Practice Address - Fax:602-900-0969
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBSBHT101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203827Medicaid
AZ125011Medicaid
AZ1740851542OtherJANUARY HARTZE INDIVIDUAL NPI
AZ1043982747OtherHEALING HARTZE ORGANIZATION NPI