Provider Demographics
NPI:1033101340
Name:VELLANCE, BRENDA FAYE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:FAYE
Last Name:VELLANCE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 DUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3704
Mailing Address - Country:US
Mailing Address - Phone:727-772-0038
Mailing Address - Fax:727-787-2384
Practice Address - Street 1:2843 ALTERNATE 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683
Practice Address - Country:US
Practice Address - Phone:727-772-0038
Practice Address - Fax:727-787-2384
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLMH3808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health