Provider Demographics
NPI:1487176707
Name:BRETZ, BRENDA KATHRYN
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KATHRYN
Last Name:BRETZ
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 1:26109 SE 6TH CIR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7295
Mailing Address - Country:US
Mailing Address - Phone:360-834-9085
Mailing Address - Fax:
Practice Address - Street 1:26109 SE 6TH CIR
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7295
Practice Address - Country:US
Practice Address - Phone:360-834-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)