Provider Demographics
NPI:1689173072
Name:HENNING, BRANDY NOEL (MFT MA)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:NOEL
Last Name:HENNING
Suffix:
Gender:F
Credentials:MFT MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PATINA LN
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1207
Mailing Address - Country:US
Mailing Address - Phone:949-292-4647
Mailing Address - Fax:
Practice Address - Street 1:18672 FLORIDA ST STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1925
Practice Address - Country:US
Practice Address - Phone:949-329-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT99959106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist