Provider Demographics
NPI:1568652006
Name:RISING, BREANNE MARIE (LMFT 128289)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:MARIE
Last Name:RISING
Suffix:
Gender:F
Credentials:LMFT 128289
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 CASTRO ST # 3016
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2512
Mailing Address - Country:US
Mailing Address - Phone:510-826-3359
Mailing Address - Fax:
Practice Address - Street 1:78015 MAIN ST STE 206B
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3420
Practice Address - Country:US
Practice Address - Phone:415-534-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist