Basic Information
| Provider Information | |||||||||
| NPI: | 1235478496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LITTLETON | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA MFT-T | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 513 | ||||||||
| Address2: | |||||||||
| City: | JOSHUA TREE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922520513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096453046 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 58945 BUSINESS CENTER DR SUITE D | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922847307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602289657 | ||||||||
| FaxNumber: | 7603696758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2013 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator | 225C00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.