Healthcare Provider Details

I. General information

NPI: 1861858383
Provider Name (Legal Business Name): BRYAN ZITZMAN PH.D., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 N MAIN ST STE C
ALPINE UT
84004-1477
US

IV. Provider business mailing address

770 E MAIN ST # 215
LEHI UT
84043-2293
US

V. Phone/Fax

Practice location:
  • Phone: 801-768-1441
  • Fax:
Mailing address:
  • Phone: 801-768-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3183203902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: