Healthcare Provider Details

I. General information

NPI: 1194018010
Provider Name (Legal Business Name): BRANDY LYNN TERRY LPCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S STATE ST STE G1
OREM UT
84058-6397
US

IV. Provider business mailing address

8196 N CEDAR SPRINGS RD APT Q7
EAGLE MOUNTAIN UT
84005-2630
US

V. Phone/Fax

Practice location:
  • Phone: 801-802-8608
  • Fax: 801-221-1042
Mailing address:
  • Phone: 801-400-2422
  • 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: