Healthcare Provider Details

I. General information

NPI: 1255000394
Provider Name (Legal Business Name): BREE GWINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2021
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 OCEAN VIEW AVE
SANTA CRUZ CA
95062-3363
US

IV. Provider business mailing address

545 OCEAN VIEW AVE
SANTA CRUZ CA
95062-3363
US

V. Phone/Fax

Practice location:
  • Phone: 831-316-3306
  • 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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: