Provider Demographics
NPI:1750826814
Name:BREYER, DAVID (LLP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BREYER
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 RAVEN LN
Mailing Address - Street 2:APT. 2
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2552
Mailing Address - Country:US
Mailing Address - Phone:989-737-8442
Mailing Address - Fax:888-859-9518
Practice Address - Street 1:4855 BERL DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2832
Practice Address - Country:US
Practice Address - Phone:989-737-8442
Practice Address - Fax:888-859-9518
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006470103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist