Healthcare Provider Details

I. General information

NPI: 1043970262
Provider Name (Legal Business Name): SMILE PSYCHIATRY AND BEHAVIORAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 E 12300 S UNIT 328
DRAPER UT
84020-7976
US

IV. Provider business mailing address

138 E 12300 S UNIT 328
DRAPER UT
84020-7976
US

V. Phone/Fax

Practice location:
  • Phone: 801-406-6256
  • Fax: 859-545-4978
Mailing address:
  • Phone: 801-406-6256
  • Fax: 859-545-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN BERRETT
Title or Position: OWNER
Credential: MD
Phone: 801-406-6256