Healthcare Provider Details

I. General information

NPI: 1770193559
Provider Name (Legal Business Name): BRIAN DROUBAY PHD, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 N 500 W
BRIGHAM CITY UT
84302-1751
US

IV. Provider business mailing address

569 N 500 W
BRIGHAM CITY UT
84302-1751
US

V. Phone/Fax

Practice location:
  • Phone: 801-628-8640
  • Fax:
Mailing address:
  • Phone: 801-628-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7951342-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC9640
License Number StateMS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: