Provider Demographics
NPI:1861814832
Name:SRA, BREENU (MFT)
Entity Type:Individual
Prefix:
First Name:BREENU
Middle Name:
Last Name:SRA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 WASHINGTON ST # 203
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2704
Mailing Address - Country:US
Mailing Address - Phone:408-568-6455
Mailing Address - Fax:888-706-4141
Practice Address - Street 1:51 E CAMPBELL AVE STE 106I
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2054
Practice Address - Country:US
Practice Address - Phone:408-568-6455
Practice Address - Fax:888-706-4141
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC # 53160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist