Provider Demographics
NPI:1295217875
Name:HONORE, BRENT GREGORY (AMFT)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:GREGORY
Last Name:HONORE
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 AVENUE 64
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2711
Mailing Address - Country:US
Mailing Address - Phone:323-543-2800
Mailing Address - Fax:
Practice Address - Street 1:14717 HAWTHORNE BLVD
Practice Address - Street 2:STE C
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1580
Practice Address - Country:US
Practice Address - Phone:310-355-0432
Practice Address - Fax:213-402-2101
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist