Provider Demographics
NPI:1639462542
Name:BRUMME, JOHN PHILIP (MFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:BRUMME
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S MELROSE DR STE 222
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6607
Mailing Address - Country:US
Mailing Address - Phone:760-806-4350
Mailing Address - Fax:760-806-4352
Practice Address - Street 1:410 S MELROSE DR STE 222
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6607
Practice Address - Country:US
Practice Address - Phone:760-806-4350
Practice Address - Fax:760-806-4352
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49726106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist