Basic Information
| Provider Information | |||||||||
| NPI: | 1629633342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCFARLAND | ||||||||
| FirstName: | BREONNA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., LMFT, APCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SANDERS | ||||||||
| OtherFirstName: | BREONNA | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MAIDEN NAME | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16940 HIGHWAY 14 STE C-J | ||||||||
| Address2: | |||||||||
| City: | MOJAVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935011238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618245020 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16940 HIGHWAY 14 STE C-J | ||||||||
| Address2: | |||||||||
| City: | MOJAVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935011238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618245020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2019 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | APCC6303 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 133102 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.