Healthcare Provider Details

I. General information

NPI: 1245665561
Provider Name (Legal Business Name): CAROL LOUISE BREILING PSYD, CATC-V, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N COTTONWOOD ST
WOODLAND CA
95695-6646
US

IV. Provider business mailing address

2635 KOKANEE WAY
SACRAMENTO CA
95826-1912
US

V. Phone/Fax

Practice location:
  • Phone: 530-341-7543
  • Fax:
Mailing address:
  • Phone: 707-365-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSB94026604
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number124395
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSB94026604
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSB94026604
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT124395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: