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Organization
NAUTICO INCORPORATED
Active
Organization
NAUTICO INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEVERLY M BREAKEY L.M.F.T. (CLINICAL COORDINATOR)
(209) 334-2053
Entity
Organization
Contact information
Practice address
1420 W KETTLEMAN LN, SUITE R, LODI, CA 95242-4557
(209) 334-2053
(209) 333-4414
Mailing address
1420 W KETTLEMAN LN, SUITE R, LODI, CA 95242-4557
(209) 334-2053
(209) 333-4414
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MFC30755
CA
Other
Enumeration date
01/15/2011
Last updated
01/15/2011
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