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General NPI Number Information
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NPI Number | 1912638412
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Entity Type | Individual
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Provider Name | BRENDA BAGHERPOUR
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Gender | Female
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 1812 LINDEN DR
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City | DENTON
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State | TX
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Zip | 76201-2564
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Country | US
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Telephone | 940-765-5530
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Fax | 206-401-7843
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Provider Business Mailing Address
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Address Line | PO BOX 1350
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City | FORNEY
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State | TX
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Zip | 75126-1350
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Country | US
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Telephone | 940-252-4101
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Fax | 206-401-7843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 53901
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License Number State | TX
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