Individual
BRALEY BROOKE KLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 PASADENA AVE, SOUTH PASADENA, CA 91030-2919
(323) 344-5536
Mailing address
205 PASADENA AVE, SOUTH PASADENA, CA 91030-2919
(323) 344-5536
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7184
MEDI-CAL
CA
01
—
7368
MEDI-CAL
CA
01
—
7667
MEDI-CAL
CA
01
—
7708
MEDI-CAL
CA
Enumeration date
04/05/2011
Last updated
06/10/2013
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