Provider Demographics
NPI:1740299015
Name:ABBOTT, BRIAN S (MFT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 FERN RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE
Mailing Address - State:CA
Mailing Address - Zip Code:96096-9508
Mailing Address - Country:US
Mailing Address - Phone:530-472-3163
Mailing Address - Fax:
Practice Address - Street 1:2640 BRESLAUER WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-4246
Practice Address - Country:US
Practice Address - Phone:530-229-8047
Practice Address - Fax:530-225-3866
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist