Provider Demographics
NPI:1215289343
Name:SPENCER, BRENDEEN ALLRED (LCSW)
Entity type:Individual
Prefix:
First Name:BRENDEEN
Middle Name:ALLRED
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRENDEEN
Other - Middle Name:ALLRED
Other - Last Name:LONGORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3025 YANKEE CLIPPER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3510
Mailing Address - Country:US
Mailing Address - Phone:702-906-5550
Mailing Address - Fax:
Practice Address - Street 1:3025 YANKEE CLIPPER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3510
Practice Address - Country:US
Practice Address - Phone:702-906-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-13
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5486-C1041C0700X
UT6025235-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical