Provider Demographics
NPI:1780999466
Name:SMITH, BRENDA JEANENE (PC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JEANENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 S SUNBURY RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9345
Mailing Address - Country:US
Mailing Address - Phone:614-865-0513
Mailing Address - Fax:614-865-0513
Practice Address - Street 1:975 S SUNBURY RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-9345
Practice Address - Country:US
Practice Address - Phone:614-865-0513
Practice Address - Fax:614-865-0513
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional