Healthcare Provider Details

I. General information

NPI: 1508112145
Provider Name (Legal Business Name): BRENDA J. HULPHERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 07/09/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE OF NEVADA RURAL CLINICS DOUGLAS 1528 HWY 395 STE 100
GARDNERVILLE NV
89410-5226
US

IV. Provider business mailing address

727 FAIRVIEW DR STE A
CARSON CITY NV
89701
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-3671
  • Fax: 775-782-6639
Mailing address:
  • Phone: 775-684-5000
  • Fax: 775-687-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5676866-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5676866-3501
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7738-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: