Provider Demographics
NPI:1083800304
Name:BREWER, JODY LYN (MFT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYN
Last Name:BREWER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LYN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:246 PEACEFUL LN
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-7041
Mailing Address - Country:US
Mailing Address - Phone:661-203-4022
Mailing Address - Fax:
Practice Address - Street 1:246 PEACEFUL LN
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-7041
Practice Address - Country:US
Practice Address - Phone:661-203-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF54601106H00000X
CAMFC47161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist