Provider Demographics
NPI:1023154358
Name:BREWER, MARK C (MFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:BREWER
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 1:3634 MARJORIE LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2727
Mailing Address - Country:US
Mailing Address - Phone:760-717-8648
Mailing Address - Fax:
Practice Address - Street 1:1207 CARLSBAD VILLAGE DR STE O
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1958
Practice Address - Country:US
Practice Address - Phone:760-500-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist