1336897198 NPI number — BRENDA W. DILLINGHAM LMFT, LLC

Table of content: (NPI 1336897198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336897198 NPI number — BRENDA W. DILLINGHAM LMFT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRENDA W. DILLINGHAM LMFT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336897198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BRENDA W DILLINGHAM PTY 13518 2250 NW 114TH AVE UNIT 1P
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33192-4177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-340-5321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11108 WARM WIND WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEEKI WACHEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34613-6520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-340-5321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DILLINGHAM
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
WALKER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-340-5321

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1597905 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600881927 . This is a "MAGELLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: RQL57 . This is a "BLUE CROSS BLUE SHIELDE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1327082 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2590447 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 019193700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 726432 . This is a "UBH/OPTUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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