Provider Demographics
NPI:1588132088
Name:BRANDENBURG, KIRSTEN ASHLEY-MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ASHLEY-MARIE
Last Name:BRANDENBURG
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 1:1505 SUNFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5839
Mailing Address - Country:US
Mailing Address - Phone:626-602-5432
Mailing Address - Fax:626-963-0028
Practice Address - Street 1:1505 SUNFLOWER AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5839
Practice Address - Country:US
Practice Address - Phone:626-602-5432
Practice Address - Fax:626-963-0028
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA119168OtherLMFT