Provider Demographics
NPI:1992865943
Name:BEAVER, BRETT FOREST (MFT)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:FOREST
Last Name:BEAVER
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 1:1026 OAK GROVE RD STE 11
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3253
Mailing Address - Country:US
Mailing Address - Phone:925-646-5694
Mailing Address - Fax:
Practice Address - Street 1:1026 OAK GROVE RD STE 11
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3253
Practice Address - Country:US
Practice Address - Phone:925-646-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 21086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist