Provider Demographics
NPI:1104508928
Name:IZAGUIRRE, BRENDA LOPEZ (LCSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOPEZ
Last Name:IZAGUIRRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 SAN FELIPE BLVD APT 29
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7689
Mailing Address - Country:US
Mailing Address - Phone:512-619-5888
Mailing Address - Fax:
Practice Address - Street 1:7708 SAN FELIPE BLVD APT 29
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7689
Practice Address - Country:US
Practice Address - Phone:737-351-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX591521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical