Victoria Ann Brekelmans
Individual provider Active NPI Marriage & Family Therapist · Willits, CA
NPI 1972117653 · NPPES record last updated Aug 23, 2024
Key facts
- NPI
- 1972117653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 148876 (CA)
- Practice address
- 1750 S Main St SPC 84
Willits, CA 95490-4423 - Phone
- (707) 714-7168
- NPI assigned
- Sep 1, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Marriage and Family Therapist
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260217004012 | CA | Practitioner - Marriage and Family Therapist | 7618457649 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 148876 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PC | Marriage & Family Therapist | Current |
Accepting new patients |
Locations
99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 148876 | CA | Yes |
Addresses
Primary practice location
1750 S Main St SPC 84
Willits, CA 95490-4423
Mailing address
315 S. Main St. P.O. Box 435
Willits, CA 95490-4423
Phone (707) 714-7168
Other providers in Willits, CA
- Cletus Gary Bodensteiner
- William W Bowen
- Craig M Boyle
- Andrea Louise Braverman
- Frank A Braverman
- Pamela Anne Brown
- Joleen Buffington
- Care B&B Inc
- Lucia Carrillo
- Lyra Cavada
All providers in Willits, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.