Provider Demographics
NPI:1225473499
Name:BRINKERHOFF, CHELSEA CHRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:CHRISTINA
Last Name:BRINKERHOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:CHRISTINA
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:459 E 1000 S
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3623
Mailing Address - Country:US
Mailing Address - Phone:385-501-3351
Mailing Address - Fax:
Practice Address - Street 1:459 E 1000 S
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3623
Practice Address - Country:US
Practice Address - Phone:385-501-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT9074891-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTCHELSEA0057Medicaid