Healthcare Provider Details

I. General information

NPI: 1649195835
Provider Name (Legal Business Name): NICHOLAS VAN BREMEN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 SANTA MONICA BLVD PMB #217346
WEST HOLLYWOOD CA
90069-4109
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD PMB #217346
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 323-573-1630
  • Fax:
Mailing address:
  • Phone: 323-573-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: