Provider Demographics
NPI:1295243517
Name:BRENNER, MEGAN (CSW INTERN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:CSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 PLUMAS ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1630
Mailing Address - Country:US
Mailing Address - Phone:775-473-6532
Mailing Address - Fax:
Practice Address - Street 1:527 PLUMAS STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-473-6532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7239-S101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty