Provider Demographics
NPI:1871843086
Name:RICHINS, BRANDI LEE (BACHELOR INTERN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEE
Last Name:RICHINS
Suffix:
Gender:F
Credentials:BACHELOR INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E. 200 N.
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321
Mailing Address - Country:US
Mailing Address - Phone:435-752-0750
Mailing Address - Fax:435-752-7433
Practice Address - Street 1:90 E. 200 N.
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321
Practice Address - Country:US
Practice Address - Phone:435-752-0750
Practice Address - Fax:435-752-7433
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACHELOR INTERN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker