Provider Demographics
NPI:1003026543
Name:LEE SIMON, BRENDA K (AMFT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:K
Last Name:LEE SIMON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:K
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APCC
Mailing Address - Street 1:1841 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3234
Mailing Address - Country:US
Mailing Address - Phone:760-255-5700
Mailing Address - Fax:760-256-5092
Practice Address - Street 1:1841 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3234
Practice Address - Country:US
Practice Address - Phone:760-255-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13613101YM0800X
CA139723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health