Provider Demographics
NPI:1457726465
Name:DESIREE BRITTAIN
Entity Type:Organization
Organization Name:DESIREE BRITTAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRRITTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:619-993-2519
Mailing Address - Street 1:PO BOX 83640
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92138-3640
Mailing Address - Country:US
Mailing Address - Phone:619-993-2519
Mailing Address - Fax:
Practice Address - Street 1:4770 JESSIE AVE
Practice Address - Street 2:UNIT C
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-8878
Practice Address - Country:US
Practice Address - Phone:619-993-2519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86289251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health