Provider Demographics
NPI:1922163542
Name:BRIAN, GREGORY JAMES (MFT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JAMES
Last Name:BRIAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 ENEA CIR
Mailing Address - Street 2:SUITE 1330
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5279
Mailing Address - Country:US
Mailing Address - Phone:510-888-3477
Mailing Address - Fax:
Practice Address - Street 1:1485 ENEA CT.
Practice Address - Street 2:STE. 1330
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:510-888-3477
Practice Address - Fax:925-674-3687
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38087106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist