Healthcare Provider Details

I. General information

NPI: 1043734577
Provider Name (Legal Business Name): DANIEL BARRATT PHILLIPS LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANIEL BARRATT PHILLIPS LCMHC

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 HARRISON BLVD
OGDEN UT
84403-2061
US

IV. Provider business mailing address

3793 N PATIOSPRINGS DR
EDEN UT
84310-9741
US

V. Phone/Fax

Practice location:
  • Phone: 801-458-7159
  • Fax:
Mailing address:
  • Phone: 801-458-7159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6895880-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6895880-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: