Healthcare Provider Details

I. General information

NPI: 1922052232
Provider Name (Legal Business Name): WILLIAM PATRICK BRENNAN L.M.H.C., C.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 N NOVA RD SUITE 202
ORMOND BEACH FL
32174-4447
US

IV. Provider business mailing address

2560 EUSTACE AVE
DELTONA FL
32725-1712
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-7470
  • Fax:
Mailing address:
  • Phone: 386-789-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH4572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: