Basic Information
| Provider Information | |||||||||
| NPI: | 1669628830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TREMAIN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | KENT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1669 N. E. ST | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093384689 | ||||||||
| FaxNumber: | 9093388230 | ||||||||
| Practice Location | |||||||||
| Address1: | 1669 N E ST | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924054405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098866737 | ||||||||
| FaxNumber: | 9098813871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.