Healthcare Provider Details

I. General information

NPI: 1003106196
Provider Name (Legal Business Name): MR. BRENT LEON SIMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N 200 W STE 300
PROVO UT
84601-1690
US

IV. Provider business mailing address

750 N 200 W STE 300
PROVO UT
84601-1690
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-4760
  • Fax:
Mailing address:
  • Phone: 801-373-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14270715-3503
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: