Provider Demographics
NPI:1134256266
Name:MAMICH, BRENDA LEE
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:MAMICH
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 1:2050 HUMBOLDT RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9155
Mailing Address - Country:US
Mailing Address - Phone:530-891-1010
Mailing Address - Fax:530-895-6548
Practice Address - Street 1:109 PARMAC RD STE 1
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2218
Practice Address - Country:US
Practice Address - Phone:530-891-2986
Practice Address - Fax:530-895-6548
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)