Provider Demographics
NPI:1770948259
Name:VON HAUZEN, BRENNA THERESE (MMFT, LMFT)
Entity type:Individual
Prefix:MS
First Name:BRENNA
Middle Name:THERESE
Last Name:VON HAUZEN
Suffix:
Gender:F
Credentials:MMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 PELHAM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4187
Mailing Address - Country:US
Mailing Address - Phone:864-270-0486
Mailing Address - Fax:864-520-2866
Practice Address - Street 1:3523 PELHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4187
Practice Address - Country:US
Practice Address - Phone:864-270-0486
Practice Address - Fax:864-520-2866
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist