Provider Demographics
NPI:1164580502
Name:BRASHAW, LARRY L (MFT I)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:L
Last Name:BRASHAW
Suffix:
Gender:M
Credentials:MFT I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:FOREST RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95942
Mailing Address - Country:US
Mailing Address - Phone:530-892-1417
Mailing Address - Fax:
Practice Address - Street 1:2858 OLIVE HIGHWAY
Practice Address - Street 2:SUITES A, B, & C
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966
Practice Address - Country:US
Practice Address - Phone:530-538-2158
Practice Address - Fax:530-533-7188
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 48878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48878OtherIMF