Provider Demographics
NPI:1306627302
Name:WASHBURN, BRENNAN MYERLE (CADC-R, CRM, PSS)
Entity type:Individual
Prefix:MR
First Name:BRENNAN
Middle Name:MYERLE
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:CADC-R, CRM, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NE 4TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4646
Mailing Address - Country:US
Mailing Address - Phone:541-280-4139
Mailing Address - Fax:
Practice Address - Street 1:908 NE 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4646
Practice Address - Country:US
Practice Address - Phone:541-280-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist