Individual
MS. BRENDALIN A BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S MENTAL HEALTH
Contact information
Practice address
4713 EL NUEVA AVE, FORT PIERCE, FL 34946-1035
(407) 256-3718
Mailing address
4713 EL NUEVA AVE, FORT PIERCE, FL 34946-1035
(407) 256-3718
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
IMH18275
FL
Other
Enumeration date
05/09/2019
Last updated
05/09/2019
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