Provider Demographics
NPI:1508577172
Name:ENGELER, BRENDA (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:ENGELER
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 1:3927 N 3300 E
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:UT
Mailing Address - Zip Code:84310-9505
Mailing Address - Country:US
Mailing Address - Phone:559-246-1657
Mailing Address - Fax:
Practice Address - Street 1:3927 N 3300 E
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:UT
Practice Address - Zip Code:84310-9505
Practice Address - Country:US
Practice Address - Phone:559-246-1657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-553021041C0700X
UT9762283-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT15807582OtherCAQH