Healthcare Provider Details

I. General information

NPI: 1790287977
Provider Name (Legal Business Name): BREANN M DANESHRAD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD STE 700
CULVER CITY CA
90232-6824
US

IV. Provider business mailing address

9717 NESTLE AVE
NORTHRIDGE CA
91325-1735
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax: 310-945-3356
Mailing address:
  • Phone: 818-625-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT160661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: