Provider Demographics
NPI:1699083816
Name:GARCIA, BRENDA AZUCENA (MFT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:AZUCENA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E ENOS DR STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7215
Mailing Address - Country:US
Mailing Address - Phone:805-614-9160
Mailing Address - Fax:805-614-9363
Practice Address - Street 1:210 E ENOS DR STE A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7215
Practice Address - Country:US
Practice Address - Phone:805-614-9160
Practice Address - Fax:808-614-9363
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA97322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program