Provider Demographics
NPI:1073855847
Name:BARR, BREANNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22566 SW WASHINGTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-7923
Mailing Address - Country:US
Mailing Address - Phone:503-496-7470
Mailing Address - Fax:
Practice Address - Street 1:22566 SW WASHINGTON ST STE 201
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-7923
Practice Address - Country:US
Practice Address - Phone:503-496-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical