Provider Demographics
NPI:1205266459
Name:BRENNAN, CATHERINE (QMHA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 SW PARK AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3197
Mailing Address - Country:US
Mailing Address - Phone:503-962-9855
Mailing Address - Fax:
Practice Address - Street 1:2073 SW PARK AVE APT 111
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3197
Practice Address - Country:US
Practice Address - Phone:503-962-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor