Provider Demographics
NPI:1598229684
Name:BRANDENBURG, KATY (LMHC)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1094
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1094
Mailing Address - Country:US
Mailing Address - Phone:805-705-9671
Mailing Address - Fax:
Practice Address - Street 1:32 PEA PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8302
Practice Address - Country:US
Practice Address - Phone:831-425-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109565101YM0800X
HIMHC-960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health