Provider Demographics
NPI:1477689677
Name:BRENEK, DEB S (MS)
Entity type:Individual
Prefix:
First Name:DEB
Middle Name:S
Last Name:BRENEK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:SUE
Other - Last Name:FRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2306 W AVENUE K
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4225
Mailing Address - Country:US
Mailing Address - Phone:325-227-6568
Mailing Address - Fax:
Practice Address - Street 1:2306 W AVENUE K
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-4225
Practice Address - Country:US
Practice Address - Phone:325-227-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12527170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125967OtherMHN