Provider Demographics
NPI:1598017139
Name:GUADALUPE, BRENDA L (LMFT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:GUADALUPE
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 1:4225 OCEANSIDE BLVD STE H #263
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3473
Mailing Address - Country:US
Mailing Address - Phone:760-237-8736
Mailing Address - Fax:
Practice Address - Street 1:4612 DORAL CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6148
Practice Address - Country:US
Practice Address - Phone:760-237-8736
Practice Address - Fax:855-492-1617
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92857106H00000X
CA109520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist