Provider Demographics
NPI:1891540084
Name:GILLESPIE, BRENDA K (MA, LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MA, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2201 S W S YOUNG DR STE 116A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5314
Mailing Address - Country:US
Mailing Address - Phone:254-213-3705
Mailing Address - Fax:
Practice Address - Street 1:2201 S W S YOUNG DR STE 116A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5314
Practice Address - Country:US
Practice Address - Phone:254-213-3705
Practice Address - Fax:254-230-1007
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional