Provider Demographics
NPI:1104361120
Name:VANSLOOTEN, BREANN
Entity Type:Individual
Prefix:
First Name:BREANN
Middle Name:
Last Name:VANSLOOTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 SAN VINCENTE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1016
Mailing Address - Country:US
Mailing Address - Phone:925-812-4221
Mailing Address - Fax:
Practice Address - Street 1:180 E LELAND RD STE A&B
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4949
Practice Address - Country:US
Practice Address - Phone:925-427-9100
Practice Address - Fax:925-427-9102
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)