Provider Demographics
NPI:1174094007
Name:STREETER, BRIENN SIRAH
Entity type:Individual
Prefix:
First Name:BRIENN
Middle Name:SIRAH
Last Name:STREETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 GETTYSBURG PL APT 30
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-9204
Mailing Address - Country:US
Mailing Address - Phone:209-326-5935
Mailing Address - Fax:
Practice Address - Street 1:6131 GETTYSBURG PL APT 30
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-9204
Practice Address - Country:US
Practice Address - Phone:209-326-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician