Healthcare Provider Details

I. General information

NPI: 1295719656
Provider Name (Legal Business Name): CHRISTINE G BREWER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE M GUEULETTE

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26777 LORAIN RD STE 410
NORTH OLMSTED OH
44070-3224
US

IV. Provider business mailing address

PO BOX 24242
CLEVELAND OH
44124-0242
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-2273
  • Fax: 216-896-0735
Mailing address:
  • Phone: 216-839-2273
  • Fax: 216-896-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0003722
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6176
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: