Healthcare Provider Details

I. General information

NPI: 1063733764
Provider Name (Legal Business Name): BRIAN K CAMPBELL LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3149 N HWY 89 #303
PLEASANT VIEW UT
84404-1201
US

IV. Provider business mailing address

3149 N HWY 89 #303
PLEASANT VIEW UT
84404-1201
US

V. Phone/Fax

Practice location:
  • Phone: 801-782-6600
  • Fax: 801-782-6551
Mailing address:
  • Phone: 801-782-6600
  • Fax: 801-782-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number352006-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: