Provider Demographics
NPI:1255886594
Name:ECHOLS, BRENDA YVONNE (CMT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:YVONNE
Last Name:ECHOLS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7046 LILLIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-3042
Mailing Address - Country:US
Mailing Address - Phone:314-368-6875
Mailing Address - Fax:
Practice Address - Street 1:7046 LILLIAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-3042
Practice Address - Country:US
Practice Address - Phone:314-368-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E0000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health