Provider Demographics
NPI:1558734624
Name:BREYER, THERESA (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:BREYER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 E 13 MILE RD
Mailing Address - Street 2:# 300
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5000
Mailing Address - Country:US
Mailing Address - Phone:586-573-1810
Mailing Address - Fax:
Practice Address - Street 1:12220 E 13 MILE RD
Practice Address - Street 2:# 300
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5000
Practice Address - Country:US
Practice Address - Phone:586-573-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010983541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical