Provider Demographics
NPI:1619261179
Name:MISCOVICH, BRENDA LYNN (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LYNN
Last Name:MISCOVICH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BRANT DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9482
Mailing Address - Country:US
Mailing Address - Phone:740-336-1814
Mailing Address - Fax:
Practice Address - Street 1:260 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:OH
Practice Address - Zip Code:45773-8005
Practice Address - Country:US
Practice Address - Phone:740-336-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YP2500X101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional