Provider Demographics
NPI:1518111764
Name:WHITFIELD, BRENDA ELLEN (LPC, RPT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELLEN
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 N SAN PATRICIO ST
Mailing Address - Street 2:
Mailing Address - City:GOLIAD
Mailing Address - State:TX
Mailing Address - Zip Code:77963-3948
Mailing Address - Country:US
Mailing Address - Phone:361-645-8485
Mailing Address - Fax:361-645-8485
Practice Address - Street 1:1373 N SAN PATRICIO ST
Practice Address - Street 2:
Practice Address - City:GOLIAD
Practice Address - State:TX
Practice Address - Zip Code:77963-3948
Practice Address - Country:US
Practice Address - Phone:361-645-8485
Practice Address - Fax:361-645-8485
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional