Healthcare Provider Details

I. General information

NPI: 1750879987
Provider Name (Legal Business Name): ROSEMARIE ELAINE BRINIG CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E. FT. UNION C118
MIDVALE UT
84047
US

IV. Provider business mailing address

75 E FORT UNION BLVD STE C118
MIDVALE UT
84047-5512
US

V. Phone/Fax

Practice location:
  • Phone: 801-792-4867
  • Fax: 866-421-6132
Mailing address:
  • Phone: 801-440-9335
  • Fax: 866-421-6132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number372067-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: