Provider Demographics
NPI:1164962460
Name:ELLEDGE, BRENDA DARLENE (MED, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DARLENE
Last Name:ELLEDGE
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:DARLENE
Other - Last Name:ESPARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 PEBBLEBROOK
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:328 PEBBLEBROOK
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154
Practice Address - Country:US
Practice Address - Phone:972-268-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health