Provider Demographics
NPI:1194856633
Name:LEA-SEWELL, BRANDY NICOLE (MS)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:NICOLE
Last Name:LEA-SEWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:BRANDY
Other - Middle Name:NICOLE
Other - Last Name:LEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17800 HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-242-6333
Mailing Address - Fax:760-946-0819
Practice Address - Street 1:58967 BUSINESS CENTER DR.
Practice Address - Street 2:SUITES C/D
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-369-3130
Practice Address - Fax:760-365-2695
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health