Healthcare Provider Details

I. General information

NPI: 1689921959
Provider Name (Legal Business Name): BRENDA IVONNE AESCHBACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3012
US

IV. Provider business mailing address

8510 BALBOA BLVD STE 150
NORTHRIDGE CA
91325-5810
US

V. Phone/Fax

Practice location:
  • Phone: 818-432-5025
  • Fax: 818-766-3926
Mailing address:
  • Phone: 818-205-5193
  • Fax: 818-540-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: