Provider Demographics
NPI:1356935696
Name:HOBAN, BRIELLE E
Entity type:Individual
Prefix:
First Name:BRIELLE
Middle Name:E
Last Name:HOBAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIELLE
Other - Middle Name:E
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4083 N PEACH AVE APT 124
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-8402
Mailing Address - Country:US
Mailing Address - Phone:559-203-2442
Mailing Address - Fax:
Practice Address - Street 1:693 W BULLARD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1607
Practice Address - Country:US
Practice Address - Phone:916-380-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health