Provider Demographics
NPI:1447935481
Name:BREAUX, SHEVAN (LMFT)
Entity type:Individual
Prefix:
First Name:SHEVAN
Middle Name:
Last Name:BREAUX
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1747
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92572-1747
Mailing Address - Country:US
Mailing Address - Phone:951-367-7410
Mailing Address - Fax:
Practice Address - Street 1:19124 BERGAMONT DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6203
Practice Address - Country:US
Practice Address - Phone:951-367-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist