Provider Demographics
NPI:1033245873
Name:BRINEGAR, JERRY (LMFT)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:BRINEGAR
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 OGLETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2135
Mailing Address - Country:US
Mailing Address - Phone:706-549-7755
Mailing Address - Fax:706-549-0428
Practice Address - Street 1:840 HAWTHORNE AVE # B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2116
Practice Address - Country:US
Practice Address - Phone:706-549-7755
Practice Address - Fax:706-549-0428
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist