Provider Demographics
NPI:1962809426
Name:BREHM, JODY (LPC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:BREHM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N 1ST ST STE 12
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1677
Mailing Address - Country:US
Mailing Address - Phone:503-949-2031
Mailing Address - Fax:
Practice Address - Street 1:104 N 1ST ST STE 12
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1677
Practice Address - Country:US
Practice Address - Phone:503-949-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4117101YM0800X
ORR3279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health