Provider Demographics
NPI:1184160970
Name:HOBBS, BRANDI (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:HOBBS
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 1:1955 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1510
Mailing Address - Country:US
Mailing Address - Phone:208-526-0218
Mailing Address - Fax:
Practice Address - Street 1:1955 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1510
Practice Address - Country:US
Practice Address - Phone:208-526-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36202104100000X
ID384391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID36202OtherBUREAU OF OCCUPATIONAL LICENSES
IDLCSW-38439OtherDIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSES