Healthcare Provider Details

I. General information

NPI: 1487745410
Provider Name (Legal Business Name): MR. ANDREW ADAM BRIEFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 W BEARCAT DR
SALT LAKE CITY UT
84115-2519
US

IV. Provider business mailing address

1399 S 700 E
SALT LAKE CITY UT
84105-2149
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-2846
  • Fax:
Mailing address:
  • Phone: 801-712-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6171608-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6171608-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: