Healthcare Provider Details

I. General information

NPI: 1396107595
Provider Name (Legal Business Name): BRIAN BERRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 W MAIN ST STE A209
LEHI UT
84043-6760
US

IV. Provider business mailing address

2183 W MAIN ST STE A209
LEHI UT
84043-6760
US

V. Phone/Fax

Practice location:
  • Phone: 801-406-6256
  • Fax:
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 Number12365803-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA155219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: