Provider Demographics
NPI:1134605827
Name:BRENARD, GEORGE HENRY
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HENRY
Last Name:BRENARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400A ECHO LN
Mailing Address - Street 2:
Mailing Address - City:LOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:95551-9627
Mailing Address - Country:US
Mailing Address - Phone:707-683-5201
Mailing Address - Fax:
Practice Address - Street 1:400A ECHO LN
Practice Address - Street 2:
Practice Address - City:LOLETA
Practice Address - State:CA
Practice Address - Zip Code:95551-9627
Practice Address - Country:US
Practice Address - Phone:707-683-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral