Individual
BREANA MARIE LUKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
216 W LOS ANGELES DR, VISTA, CA 92083-3101
(760) 630-4035
Mailing address
216 W LOS ANGELES DR, VISTA, CA 92083-3101
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336201490
—
CA
Enumeration date
02/11/2020
Last updated
02/11/2020
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