Provider Demographics
NPI:1134558356
Name:WAINWRIGHT, BRIAN EDWARD (MFT INTERN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:WAINWRIGHT
Suffix:
Gender:
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 13TH ST. PACIFIC GROVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-6310
Mailing Address - Country:US
Mailing Address - Phone:530-519-5589
Mailing Address - Fax:
Practice Address - Street 1:205 13TH ST. PACIFIC GROVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-9395
Practice Address - Country:US
Practice Address - Phone:530-519-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110402106H00000X
CA85490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist