Healthcare Provider Details

I. General information

NPI: 1184128464
Provider Name (Legal Business Name): BRENDA KAY THAYER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4226 PENRITH CT
DUBLIN OH
43016-8276
US

IV. Provider business mailing address

PO BOX 72
LINCOLN CITY OR
97367-0072
US

V. Phone/Fax

Practice location:
  • Phone: 888-536-9963
  • Fax:
Mailing address:
  • Phone: 907-500-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number118152
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number24311
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number74665
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number81856
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTPMC4475
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5575
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3086
License Number StateMS
# 8
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2606172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: