Provider Demographics
NPI:1104684182
Name:BASSETT-EDDINGTON, BRENDA (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BASSETT-EDDINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 S PRICE FARM CT
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-5529
Mailing Address - Country:US
Mailing Address - Phone:832-283-8140
Mailing Address - Fax:
Practice Address - Street 1:9475 BRIAR VILLAGE PT STE 215
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7908
Practice Address - Country:US
Practice Address - Phone:719-357-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health