Basic Information
| Provider Information | |||||||||
| NPI: | 1629362678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRENK | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | LINNETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10250 COMMERCE AVE APT 222 | ||||||||
| Address2: | |||||||||
| City: | TUJUNGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910423507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183178578 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 E FOOTHILL BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267445230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2011 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | B1007160222 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.