Provider Demographics
NPI:1144875923
Name:MIKO, BRENDA (LCSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MIKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3914 MURPHY CANYON RD STE A237
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4416
Mailing Address - Country:US
Mailing Address - Phone:619-320-8944
Mailing Address - Fax:
Practice Address - Street 1:3914 MURPHY CANYON RD STE A237
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4416
Practice Address - Country:US
Practice Address - Phone:619-320-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health