Provider Demographics
NPI:1366653362
Name:COURTNEY, BRETON MARCEL-CHARLES
Entity Type:Individual
Prefix:
First Name:BRETON
Middle Name:MARCEL-CHARLES
Last Name:COURTNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5247
Mailing Address - Country:US
Mailing Address - Phone:925-706-2168
Mailing Address - Fax:
Practice Address - Street 1:333 HEGENBERGER RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1420
Practice Address - Country:US
Practice Address - Phone:510-383-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor