Healthcare Provider Details

I. General information

NPI: 1508349358
Provider Name (Legal Business Name): MONTE BRYCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 S 1000 E STE 3
DRAPER UT
84020-3203
US

IV. Provider business mailing address

12222 S 1000 E STE 3
DRAPER UT
84020-3203
US

V. Phone/Fax

Practice location:
  • Phone: 801-987-3592
  • Fax:
Mailing address:
  • Phone: 801-987-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number13205949-2506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: