Provider Demographics
NPI:1104361740
Name:WILHELM, BRENDA S (MA, LSW, LPCC, LSC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:S
Last Name:WILHELM
Suffix:
Gender:F
Credentials:MA, LSW, LPCC, LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E COURT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2467
Mailing Address - Country:US
Mailing Address - Phone:419-575-7910
Mailing Address - Fax:419-386-0981
Practice Address - Street 1:141 E COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2467
Practice Address - Country:US
Practice Address - Phone:419-575-7910
Practice Address - Fax:419-386-0981
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003505101YP2500X
OHS.0009495104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker