Breanna Rose Pennypacker
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Burton, OH
NPI 1497526792 · NPPES record last updated Jul 8, 2024
Key facts
- NPI
- 1497526792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CDCA.175932 (OH)
- Practice address
- 14707 S Cheshire St
Burton, OH 44021-9601 - Phone
- (440) 887-1100
- Fax
- (440) 887-1103
- NPI assigned
- Jan 15, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.175932 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| C.2406080 | OH | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McIntyre Center Inc. | Current |
Accepting new patients | |
| McIntyre Center Inc. | Past |
Accepting new patients |
Locations
14707 S Cheshire St
Burton, OH 44021
Phone 4408871100 ext. 243
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.175932 | OH | Yes |
| Professional Counselor | 101YP2500X | C.2406080 | OH |
Addresses
Primary practice location
14707 S Cheshire St
Burton, OH 44021-9601
Mailing address
11176 Claridon Troy Rd
Chardon, OH 44024-9469
Other practice location 1
6900 Ridge Rd
Parma, OH 44129-5650
Phone (440) 887-1100 ext. 243
Other providers in Burton, OH
- Melinda R McDaniel
- Terri McIntee
- Elizabeth Anne Miller
- James D Mussler
- Anthony S Parrino
- Victoria Peterson
- David Pines Jr.
- Julie Lynn Rice
- Robert W Blair DC Inc
- Dianna L Rutherford
All providers in Burton, OH · Addiction (Substance Use Disorder) Counselor in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.