Healthcare Provider Details

I. General information

NPI: 1215239041
Provider Name (Legal Business Name): COURTNEY MICHAEL BRENNAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SE 2ND ST
PENDLETON OR
97801-2224
US

IV. Provider business mailing address

880 MAIN ST
AUMSVILLE OR
97325-9013
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-6207
  • Fax: 541-276-4628
Mailing address:
  • Phone: 360-567-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: