Provider Demographics
NPI:1396620811
Name:MUCHMORE, JOSEPH BRENNAN (PPS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRENNAN
Last Name:MUCHMORE
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:MR
Other - First Name:BRENNAN
Other - Middle Name:
Other - Last Name:MUCHMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PPS
Mailing Address - Street 1:141 CATALPA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1518
Mailing Address - Country:US
Mailing Address - Phone:720-985-8905
Mailing Address - Fax:
Practice Address - Street 1:7155 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9718
Practice Address - Country:US
Practice Address - Phone:831-335-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240157912101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool