Provider Demographics
NPI:1457539306
Name:BRANDENBURG, LEAH (MFTI)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9650 ZELZAH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2003
Mailing Address - Country:US
Mailing Address - Phone:818-993-9311
Mailing Address - Fax:
Practice Address - Street 1:40005 10TH ST W
Practice Address - Street 2:SUITE 106
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3037
Practice Address - Country:US
Practice Address - Phone:661-265-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-02
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF87843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist