Provider Demographics
NPI:1417707944
Name:SEIGNEMARTIN, BRANDY (APCC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:SEIGNEMARTIN
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 JALON RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-3938
Mailing Address - Country:US
Mailing Address - Phone:785-408-0646
Mailing Address - Fax:
Practice Address - Street 1:2512 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3264
Practice Address - Country:US
Practice Address - Phone:785-408-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health