Provider Demographics
NPI:1225289176
Name:RUSSELL, BRENDA SUE (LMFT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 LA TIJERA CT
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-8953
Mailing Address - Country:US
Mailing Address - Phone:805-441-3882
Mailing Address - Fax:
Practice Address - Street 1:911 21ST ST STE 205
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-1722
Practice Address - Country:US
Practice Address - Phone:805-441-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225289176OtherDRUG AND ALCOHOL SPECIALIST