Provider Demographics
NPI:1083949580
Name:BRINKERHOFF, JAN JENSEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:JENSEN
Last Name:BRINKERHOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 LANE 10
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9239
Mailing Address - Country:US
Mailing Address - Phone:307-754-9795
Mailing Address - Fax:
Practice Address - Street 1:253 EAST 2ND
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-9239
Practice Address - Country:US
Practice Address - Phone:307-254-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical