Provider Demographics
NPI:1770079691
Name:CONN, BRELYNN ASHTYN
Entity type:Individual
Prefix:
First Name:BRELYNN
Middle Name:ASHTYN
Last Name:CONN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 EATON RD APT 45
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8323
Mailing Address - Country:US
Mailing Address - Phone:707-616-2343
Mailing Address - Fax:530-894-5791
Practice Address - Street 1:572 RIO LINDO AVE STE 206
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1851
Practice Address - Country:US
Practice Address - Phone:530-894-5933
Practice Address - Fax:530-894-5791
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health