Provider Demographics
NPI:1851867147
Name:BRENNER, COLLEEN APRIL (PHD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:APRIL
Last Name:BRENNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOMA LINDA UNIVERSITY, DEPARTMENT OF PSYCHOLOGY
Mailing Address - Street 2:11130 ANDERSON STREET
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350
Mailing Address - Country:US
Mailing Address - Phone:909-558-8617
Mailing Address - Fax:
Practice Address - Street 1:1710 BARTON RD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5304
Practice Address - Country:US
Practice Address - Phone:909-558-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29154103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical