Provider Demographics
NPI:1083310734
Name:TELLEZ-OLMOS, BRENDA JACQUELINE (LPCC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JACQUELINE
Last Name:TELLEZ-OLMOS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:J
Other - Last Name:OLMOS-SALDANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 FARMLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8632
Mailing Address - Country:US
Mailing Address - Phone:209-384-5533
Mailing Address - Fax:
Practice Address - Street 1:100 FARMLAND AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8632
Practice Address - Country:US
Practice Address - Phone:209-384-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty