Provider Demographics
NPI:1508112145
Name:HULPHERS, BRENDA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:J
Last Name:HULPHERS
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 1:727 FAIRVIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701
Mailing Address - Country:US
Mailing Address - Phone:775-684-5000
Mailing Address - Fax:775-687-1181
Practice Address - Street 1:STATE OF NEVADA RURAL CLINICS DOUGLAS
Practice Address - Street 2:1528 HWY 395 STE 100
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5226
Practice Address - Country:US
Practice Address - Phone:775-782-3671
Practice Address - Fax:775-782-6639
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5676866-3501104100000X, 1041C0700X
NV7738-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1508112145Medicaid