MEDICARE: DR. BRIAN JOSEPH BREILING PSY.D.

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	MK24257	CA

General Provider Information

NPI Number	:	1427341148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JOSEPH BREILING PSY.D.

Provider Business Mailing Address
First Line	:	16470 INDIAN FLAT RD
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-8703
Country	:	US
Telephone Number	:	530-478-9592
Fax Number	:	530-478-9969

Provider Business Practice Location Address
First Line	:	16470 INDIAN FLAT RD
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-8703
Country	:	US
Telephone Number	:	530-478-9592
Fax Number	:	530-478-9969

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

Provider Enumeration Date	:	05/27/2011
Last Update Date	:	05/27/2011

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