Healthcare Provider Details

I. General information

NPI: 1932653078
Provider Name (Legal Business Name): BRICE G HILDRETH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ASPENWOOD DR
TURLOCK CA
95380-6563
US

IV. Provider business mailing address

2101 ASPENWOOD DR
TURLOCK CA
95380-6563
US

V. Phone/Fax

Practice location:
  • Phone: 209-341-1824
  • Fax:
Mailing address:
  • Phone: 209-341-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberASW93324
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: