Provider Demographics
NPI:1649427725
Name:MASHBURN, BRENDA LOU (LMFT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LOU
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N CHALKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1373
Mailing Address - Country:US
Mailing Address - Phone:205-422-4697
Mailing Address - Fax:205-655-3851
Practice Address - Street 1:128 N CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1373
Practice Address - Country:US
Practice Address - Phone:205-422-4697
Practice Address - Fax:205-655-3851
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist