Healthcare Provider Details

I. General information

NPI: 1508577172
Provider Name (Legal Business Name): BRENDA ENGELER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3927 N 3300 E
LIBERTY UT
84310-9505
US

IV. Provider business mailing address

3927 N 3300 E
LIBERTY UT
84310-9505
US

V. Phone/Fax

Practice location:
  • Phone: 559-246-1657
  • Fax:
Mailing address:
  • Phone: 559-246-1657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-55302
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9762283-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: