Provider Demographics
NPI:1477978351
Name:MONTIEL-BAHLAWAN, BRENDA (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MONTIEL-BAHLAWAN
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:MONTIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1122 NW 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2914
Mailing Address - Country:US
Mailing Address - Phone:956-289-7025
Mailing Address - Fax:956-289-7257
Practice Address - Street 1:1122 NW 143RD AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2914
Practice Address - Country:US
Practice Address - Phone:956-289-7025
Practice Address - Fax:956-289-7257
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24902101YM0800X
TX69127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138708613Medicaid
TX00R945OtherMEDICARE
TX138708611Medicaid