Provider Demographics
NPI:1396904678
Name:RICHARD, BRENDA GAIL (LMSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:GAIL
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HEBRIDES LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-5552
Mailing Address - Country:US
Mailing Address - Phone:479-414-2723
Mailing Address - Fax:
Practice Address - Street 1:36 HEBRIDES LN
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-5552
Practice Address - Country:US
Practice Address - Phone:479-414-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1965-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1965-MOtherARKANSAS SOCIAL WORK LICENSING BOARD