Provider Demographics
NPI:1609201151
Name:DEE, BRENDA (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:DEE
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 1:5460 W FRANKLIN RD STE I
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1080
Mailing Address - Country:US
Mailing Address - Phone:208-378-9636
Mailing Address - Fax:208-485-9826
Practice Address - Street 1:5460 W FRANKLIN RD STE I
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1080
Practice Address - Country:US
Practice Address - Phone:208-378-9636
Practice Address - Fax:208-485-9826
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW344591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1609201151Medicaid
ID20009154Medicare PIN