Provider Demographics
NPI:1497895718
Name:STEWART-WALKER, BRENDA DENISE (MSC/MFT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DENISE
Last Name:STEWART-WALKER
Suffix:
Gender:F
Credentials:MSC/MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W G ST STE C
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3657
Mailing Address - Country:US
Mailing Address - Phone:209-710-6107
Mailing Address - Fax:209-827-2009
Practice Address - Street 1:40 W G ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3657
Practice Address - Country:US
Practice Address - Phone:209-710-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT110456106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306922554Medicaid
CA1841342318Medicaid
CA1265520183Medicaid