MEDICARE: BREENU SRA 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 # 53160	CA

General Provider Information

NPI Number	:	1861814832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREENU SRA MFT

Provider Business Mailing Address
First Line	:	859 WASHINGTON ST # 203
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-2704
Country	:	US
Telephone Number	:	408-568-6455
Fax Number	:	888-706-4141

Provider Business Practice Location Address
First Line	:	51 E CAMPBELL AVE STE 106I
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-2054
Country	:	US
Telephone Number	:	408-568-6455
Fax Number	:	888-706-4141

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

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	02/16/2016

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