Provider Demographics
NPI:1619512878
Name:SALES, BRENDA LEE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:SALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 N 1300 W
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4965
Mailing Address - Country:US
Mailing Address - Phone:435-628-9310
Mailing Address - Fax:
Practice Address - Street 1:948 N 1300 W
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4965
Practice Address - Country:US
Practice Address - Phone:435-628-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)