Provider Demographics
NPI:1134137359
Name:VANAMBURGH, BRENDA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:B
Last Name:VANAMBURGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4613
Mailing Address - Country:US
Mailing Address - Phone:817-924-5016
Mailing Address - Fax:
Practice Address - Street 1:3815 LISBON ST STE 202
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5673
Practice Address - Country:US
Practice Address - Phone:817-738-4660
Practice Address - Fax:817-738-4773
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658101YP2500X
TX1851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist