Provider Demographics
NPI:1417386947
Name:BENTLEY, BRENDA BOLLING (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:BOLLING
Last Name:BENTLEY
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:P.O. BOX 822771
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182
Mailing Address - Country:US
Mailing Address - Phone:817-576-4117
Mailing Address - Fax:817-576-4117
Practice Address - Street 1:1908 OLD YORK DRIVE
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-576-4117
Practice Address - Fax:817-576-4117
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical