Healthcare Provider Details

I. General information

NPI: 1659137792
Provider Name (Legal Business Name): BRADY C EISERT LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 E 820 N UPPR LEVL
OREM UT
84097-5481
US

IV. Provider business mailing address

1452 E 820 N UPPR LEVL
OREM UT
84097-5481
US

V. Phone/Fax

Practice location:
  • Phone: 801-648-9664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCMFT03386
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14271132-3902
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2025003128
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: