Provider Demographics
NPI:1821514365
Name:KLEBANOFF, BREANNA JEAN GAINES (LMFT)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:JEAN GAINES
Last Name:KLEBANOFF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10731 TREENA ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1040
Mailing Address - Country:US
Mailing Address - Phone:619-600-0683
Mailing Address - Fax:619-600-0683
Practice Address - Street 1:10731 TREENA ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1040
Practice Address - Country:US
Practice Address - Phone:619-600-0683
Practice Address - Fax:619-600-0683
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100519106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist