MEDICARE: MS. BREANA MARTIN AMFT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	135633	CA

General Provider Information

NPI Number	:	1962048082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BREANA MARTIN AMFT

Provider Business Mailing Address
First Line	:	2828 BAMMEL LN APT 1000
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1146
Country	:	US
Telephone Number	:	619-386-6220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 VINE ST STE 216
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5250
Country	:	US
Telephone Number	:	206-531-2757
Fax Number	:

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

Provider Enumeration Date	:	11/24/2019
Last Update Date	:	12/08/2023

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