Healthcare Provider Details

I. General information

NPI: 1962364471
Provider Name (Legal Business Name): BRIANA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 1000 W
TOOELE UT
84074-4010
US

IV. Provider business mailing address

3725 W 4100 S STE 201
WEST VALLEY CITY UT
84120-6490
US

V. Phone/Fax

Practice location:
  • Phone: 435-843-3520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14259494-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: