Provider Demographics
NPI:1891763595
Name:BRECK, BARBARA (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BRECK
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 1:2051 KAEN RD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-742-5300
Mailing Address - Fax:503-742-5304
Practice Address - Street 1:2051 KAEN RD FL 1
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4035
Practice Address - Country:US
Practice Address - Phone:503-655-8401
Practice Address - Fax:503-655-8429
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR068WCGMWEMedicare ID - Type Unspecified
ORR93811Medicare UPIN