Provider Demographics
NPI:1033222732
Name:KLASS, BRENDA M (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:M
Last Name:KLASS
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 VENTURA BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2004
Mailing Address - Country:US
Mailing Address - Phone:818-784-0990
Mailing Address - Fax:818-784-9069
Practice Address - Street 1:16550 VENTURA BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2004
Practice Address - Country:US
Practice Address - Phone:818-784-0990
Practice Address - Fax:818-784-9069
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G367780OtherGROUP NUMBER
CAZZZ37943ZOtherBLUE SHIELD GROUP #
CA00G367780OtherBLUE CROSS