Provider Demographics
NPI:1699916577
Name:BEARDSLEY, BRENDA KAY (LMFT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:BEARDSLEY
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 1:40 1/2 PALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2895
Mailing Address - Country:US
Mailing Address - Phone:310-713-3077
Mailing Address - Fax:
Practice Address - Street 1:40 1/2 PALOMA AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2895
Practice Address - Country:US
Practice Address - Phone:310-713-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist