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General NPI Number Information
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NPI Number | 1326291360
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Entity Type | Individual
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Provider Name | BRANDY ANN LIDBECK
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Gender | Female
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 5201 GREAT AMERICA PKWY STE 320
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City | SANTA CLARA
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State | CA
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Zip | 95054-1140
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 1757 PORTALS AVE
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City | CLOVIS
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State | CA
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Zip | 93611-2036
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Country | US
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Telephone | 916-992-3007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 50775
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License Number State | CA
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