Provider Demographics
NPI:1639380389
Name:BRETTHAUER, BROOK MARIAH (MS)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:MARIAH
Last Name:BRETTHAUER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MATHEWS ST
Mailing Address - Street 2:APT. #4
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2838
Mailing Address - Country:US
Mailing Address - Phone:970-495-4611
Mailing Address - Fax:
Practice Address - Street 1:2001 S SHIELDS ST
Practice Address - Street 2:BUILDING D, SUITE 203
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1827
Practice Address - Country:US
Practice Address - Phone:970-495-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist