Provider Demographics
NPI:1447478375
Name:BRENO, JEFFREY GENE
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GENE
Last Name:BRENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-3219
Mailing Address - Country:US
Mailing Address - Phone:509-327-1915
Mailing Address - Fax:
Practice Address - Street 1:1212 W SHARP AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2600
Practice Address - Country:US
Practice Address - Phone:509-242-2308
Practice Address - Fax:509-328-5236
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00053537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health