Provider Demographics
NPI:1609520642
Name:MONTGOMERY-TELFOR, BRENDA S
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:S
Last Name:MONTGOMERY-TELFOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:MONTGOMERY-TELFOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6904 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2406
Mailing Address - Country:US
Mailing Address - Phone:925-577-4732
Mailing Address - Fax:925-621-0076
Practice Address - Street 1:6904 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2406
Practice Address - Country:US
Practice Address - Phone:925-577-4732
Practice Address - Fax:925-621-0076
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty