Healthcare Provider Details

I. General information

NPI: 1891271870
Provider Name (Legal Business Name): JASON BRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 N HIGHWAY 59 STE K
MERCED CA
95348-9405
US

IV. Provider business mailing address

671 LOUGHBOROUGH DR APT 5
MERCED CA
95348-2605
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-2125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: