Healthcare Provider Details

I. General information

NPI: 1326959016
Provider Name (Legal Business Name): BRYCE GOODWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10718 S BECKSTEAD LN STE 103
SOUTH JORDAN UT
84095-2605
US

IV. Provider business mailing address

8483 S 1275 E
SANDY UT
84094-1363
US

V. Phone/Fax

Practice location:
  • Phone: 801-477-0041
  • Fax:
Mailing address:
  • Phone: 503-914-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14302686-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: