Doctor Name: | STEPHEN REX BRETHAUER |
NPI Number: | 1356411425 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 987007 |
Business Practice Address: | 123 E 4th St Wray, CO - 807581716 |
Business Phone Number: | 9703324555 |
Business Fax Number: | 9703324040 |
Mailing Address: | 30288 County Road 25, WRAY |
State: | CO |
Postal Code: | 807589383 |
Phone Number: | 9703324555 |
Fax Number: | 9703324040 |
NPI Enumeration Date: | 11/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 987007 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |