Healthcare Provider Details

I. General information

NPI: 1871324079
Provider Name (Legal Business Name): DONALD ALEXANDER BRUEY LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W SHELLEY AVE
SOUTH SALT LAKE UT
84115-3527
US

IV. Provider business mailing address

31 W SHELLEY AVE
SOUTH SALT LAKE UT
84115-3527
US

V. Phone/Fax

Practice location:
  • Phone: 385-422-3574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13975510-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: