Healthcare Provider Details

I. General information

NPI: 1639626567
Provider Name (Legal Business Name): BREJOHN MCCRARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N PARKER ST
ORANGE CA
92868-1323
US

IV. Provider business mailing address

525 N PARKER ST
ORANGE CA
92868-1323
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-5546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: