Provider Demographics
NPI:1376747535
Name:NAKAGAWA, BRENDA M (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:M
Last Name:NAKAGAWA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 CALLE PECOS
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2344
Mailing Address - Country:US
Mailing Address - Phone:805-498-2328
Mailing Address - Fax:805-499-6621
Practice Address - Street 1:1089 CALLE PECOS
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2344
Practice Address - Country:US
Practice Address - Phone:805-498-2328
Practice Address - Fax:805-499-6621
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist