Provider Demographics
NPI:1558501833
Name:LEWIS, BRANDYNN (LPCC)
Entity Type:Individual
Prefix:
First Name:BRANDYNN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:100 E ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4606
Mailing Address - Country:US
Mailing Address - Phone:707-540-2648
Mailing Address - Fax:
Practice Address - Street 1:2460 W 3RD ST STE 230
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6411
Practice Address - Country:US
Practice Address - Phone:707-540-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health