Provider Demographics
NPI:1841668258
Name:FORTUNE, BRENDA VALENZUELA (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:VALENZUELA
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:VERCELES
Other - Last Name:VALENZUELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1191 NW GOOSEBERRY CT.
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-698-4860
Mailing Address - Fax:360-698-3849
Practice Address - Street 1:1191 NW GOOSEBERRY CT
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8623
Practice Address - Country:US
Practice Address - Phone:360-698-4860
Practice Address - Fax:360-698-3849
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60573406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health