MEDICARE: KERRY BREMHORST LMFT

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	135774	CA

General Provider Information

NPI Number	:	1518738921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY BREMHORST LMFT

Provider Business Mailing Address
First Line	:	4705 LA CASA DR
Second Line	:
City	:	OAKLEY
State	:	CA
Zip	:	94561-4149
Country	:	US
Telephone Number	:	925-818-4981
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 SAND CREEK RD STE 202M
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2215
Country	:	US
Telephone Number	:	925-818-4981
Fax Number	:

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

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/15/2024

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