Basic Information
Provider Information
NPI: 1124409107
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MACPHERSON
FirstName: BRIAHNNE
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10333 EL CAMINO REAL
Address2:  
City: ATASCADERO
State: CA
PostalCode: 934225808
CountryCode: US
TelephoneNumber: 8054682000
FaxNumber:  
Practice Location
Address1: 10333 EL CAMINO REAL
Address2:  
City: ATASCADERO
State: CA
PostalCode: 934225808
CountryCode: US
TelephoneNumber: 8054682000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/15/2015
LastUpdateDate: 05/31/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/31/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X31115CAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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