Healthcare Provider Details

I. General information

NPI: 1518824713
Provider Name (Legal Business Name): BRENNAN BELLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E 100 S
ALPINE UT
84004-1726
US

IV. Provider business mailing address

620 E 100 S
ALPINE UT
84004-1726
US

V. Phone/Fax

Practice location:
  • Phone: 801-836-0297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14223944-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: