Provider Demographics
NPI:1114813441
Name:ADAME, BREANNA R (AMFT)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:R
Last Name:ADAME
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 CAMINO LN
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-8666
Mailing Address - Country:US
Mailing Address - Phone:559-706-9781
Mailing Address - Fax:
Practice Address - Street 1:49370 ROAD 426 STE B
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9052
Practice Address - Country:US
Practice Address - Phone:559-641-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT153643106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist