Provider Demographics
NPI:1225542087
Name:THYNE, BRANDEN K (MAMFT)
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:K
Last Name:THYNE
Suffix:
Gender:M
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 N MOUNTAIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-8516
Mailing Address - Country:US
Mailing Address - Phone:909-931-3388
Mailing Address - Fax:909-931-7311
Practice Address - Street 1:585 N MOUNTAIN AVE STE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-8516
Practice Address - Country:US
Practice Address - Phone:909-931-3388
Practice Address - Fax:909-931-7311
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MFC50644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist