Provider Demographics
NPI:1922155183
Name:JEFFRIES, BREANNA MARTINE (MA, MHP, RC)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARTINE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:MA, MHP, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SEATTLE MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:14270 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3720
Practice Address - Country:US
Practice Address - Phone:452-653-5006
Practice Address - Fax:425-653-5010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00039108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional