Healthcare Provider Details

I. General information

NPI: 1285618561
Provider Name (Legal Business Name): BERNARD GEORGE VETTER MSW DCSW BCD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E MONTICELLO DR
KAYSVILLE UT
84037-2805
US

IV. Provider business mailing address

206 E MONTICELLO DR
KAYSVILLE UT
84037
US

V. Phone/Fax

Practice location:
  • Phone: 801-309-1079
  • Fax:
Mailing address:
  • Phone: 801-309-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1298543501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1298543501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: