Healthcare Provider Details

I. General information

NPI: 1801703178
Provider Name (Legal Business Name): BRANDY D MOURITSEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 N 2000 W STE 6
FARR WEST UT
84404-8060
US

IV. Provider business mailing address

1812 N 2000 W STE 6
FARR WEST UT
84404-8060
US

V. Phone/Fax

Practice location:
  • Phone: 801-710-0421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: