Provider Demographics
NPI:1972117653
Name:BREKELMANS, VICTORIA ANN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:BREKELMANS
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 1:315 S. MAIN ST. P.O. BOX 435
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-4423
Mailing Address - Country:US
Mailing Address - Phone:707-714-7168
Mailing Address - Fax:
Practice Address - Street 1:1750 S MAIN ST SPC 84
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4423
Practice Address - Country:US
Practice Address - Phone:707-714-7168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist