Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | PT28096 | CA |
NPI | 1003026543 |
---|---|
Provider Name | Mrs. Brenda K. Lee |
First Address | Hesperia, CA 92345-1855 |
Second Address | Hesperia, CA 92345-1855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 13/11/2019 |