Christa Brennan LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CHRISTA BRENNAN LLC

Doing business as

Broken Bowl LLC

Practice address

819 SE Taylor St
Portland, OR 97214-2385

Phone

(732) 275-2979

NPI assigned

Apr 13, 2023

Last updated

Apr 13, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

BROKEN BOWL LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christa Brennan

Title

Owner

Phone

(732) 275-2979

Specialties & licenses 1

Addresses

Other names 1

• Broken Bowl LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Crista Brennan

  • Counselor
  • Medford, OR
  • NPI 1962799536
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681344000000",
    "number": "1184310971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5010 SE 41ST AVE APT 106",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972024278",
            "telephone_number": "732-275-2979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 SE TAYLOR ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142385",
            "telephone_number": "732-275-2979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTA BRENNAN LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROKEN BOWL LLC",
        "enumeration_date": "2023-04-13",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A",
        "authorized_official_last_name": "BRENNAN",
        "authorized_official_first_name": "CHRISTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-275-2979"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broken Bowl LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anna Chrisman, RN
• Claudia Eugenia Chriss, MPT
• Judith Christ, MPT
• Noelle Christ
• Christa Barton, ND, LLC (Balanced and Bright Wellness)
• Kelly Christen
• David P Christenot, RPH
• Christensen Counseling, LLC
• Cayle Adair Robbins Christensen, MSW
• Cayly Christensen, L.AC.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.