Provider Demographics
NPI:1194965186
Name:BRUSH, CAROL ANN (PHD,MFT)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:BRUSH
Suffix:
Gender:F
Credentials:PHD,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 N TUSTIN AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8640
Mailing Address - Country:US
Mailing Address - Phone:714-972-8404
Mailing Address - Fax:714-633-8418
Practice Address - Street 1:1450 N TUSTIN AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8640
Practice Address - Country:US
Practice Address - Phone:714-972-8404
Practice Address - Fax:714-633-8418
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30797106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 30797OtherBOARD OF BEHAVIORAL SCIENCES