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NPI Code Detail

MEDICARE: BLAKE BRINKERHOFF

MEDICARE: BLAKE BRINKERHOFF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
2106S00000XBehavior Technician
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1942672589
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE BRINKERHOFF
Provider Business Mailing Address
First Line : 6013 S REDWOOD RD
Second Line :
City : TAYLORSVILLE
State : UT
Zip : 84123-5220
Country : US
Telephone Number : 801-255-5131
Fax Number :
Provider Business Practice Location Address
First Line : 5558 S 1900 W
Second Line :
City : TAYLORSVILLE
State : UT
Zip : 84129-9007
Country : US
Telephone Number : 801-255-5131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2015
Last Update Date : 07/15/2024

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Directions to “ BLAKE BRINKERHOFF ” Practice Location

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