Provider Demographics
NPI:1760639835
Name:BRINKER, AUDIE NELSON
Entity Type:Individual
Prefix:
First Name:AUDIE
Middle Name:NELSON
Last Name:BRINKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 S EL CAMINO REAL STE 205
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6281
Mailing Address - Country:US
Mailing Address - Phone:760-721-6241
Mailing Address - Fax:760-721-6291
Practice Address - Street 1:2103 S EL CAMINO REAL STE 205
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6281
Practice Address - Country:US
Practice Address - Phone:760-721-6241
Practice Address - Fax:760-721-6291
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)