Healthcare Provider Details

I. General information

NPI: 1225191984
Provider Name (Legal Business Name): BRANDON MICHAEL BURR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N STATE ST STE 3
SALINA UT
84654-1363
US

IV. Provider business mailing address

PO BOX 234
SALINA UT
84654-0234
US

V. Phone/Fax

Practice location:
  • Phone: 435-979-5218
  • Fax: 435-529-3873
Mailing address:
  • Phone: 435-979-5218
  • Fax: 435-529-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number321883-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-1062
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: