Provider Demographics
NPI:1639790421
Name:MERHAR, BREANNA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:MERHAR
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:KRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 FEDERAL AVE
Mailing Address - Street 2:APT 24
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:952-212-0294
Mailing Address - Fax:
Practice Address - Street 1:265 FEDERAL AVE
Practice Address - Street 2:APT 24
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:952-212-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-55277103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst