MEDICARE: MARK C. BREWER MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 46057	CA

General Provider Information

NPI Number	:	1023154358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK C. BREWER MFT

Provider Business Mailing Address
First Line	:	3634 MARJORIE LN
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-2727
Country	:	US
Telephone Number	:	760-717-8648
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 CARLSBAD VILLAGE DR STE O
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1958
Country	:	US
Telephone Number	:	760-500-3325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	03/03/2009

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