Provider Demographics
NPI:1184921678
Name:SALMON, BREANNE LYN
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:LYN
Last Name:SALMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:LYN
Other - Last Name:UNRUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:576 CAMINO MERCADO
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1816
Mailing Address - Country:US
Mailing Address - Phone:805-481-2823
Mailing Address - Fax:
Practice Address - Street 1:576 CAMINO MERCADO
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1816
Practice Address - Country:US
Practice Address - Phone:805-481-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT91318106H00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)