Provider Demographics
NPI:1316033251
Name:BREUER, GARY JEROME (MA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:JEROME
Last Name:BREUER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 E. BELL RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2344
Mailing Address - Country:US
Mailing Address - Phone:480-758-2552
Mailing Address - Fax:480-629-5898
Practice Address - Street 1:9821 E. BELL RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2344
Practice Address - Country:US
Practice Address - Phone:480-758-2552
Practice Address - Fax:480-629-5898
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional