Provider Demographics
NPI:1083981369
Name:SPROAT, BRIAN KELLY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KELLY
Last Name:SPROAT
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 1:2833 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-9574
Mailing Address - Country:US
Mailing Address - Phone:951-222-3006
Mailing Address - Fax:
Practice Address - Street 1:1845 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3467
Practice Address - Country:US
Practice Address - Phone:951-731-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT130604106H00000X
CA111194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist