Provider Demographics
NPI:1477974160
Name:BRECK, JOSEPH (PC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BRECK
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 N GAIA PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-8978
Mailing Address - Country:US
Mailing Address - Phone:520-490-6993
Mailing Address - Fax:
Practice Address - Street 1:3033 N GAIA PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-8978
Practice Address - Country:US
Practice Address - Phone:520-490-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-14108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional