Healthcare Provider Details

I. General information

NPI: 1285268128
Provider Name (Legal Business Name): PHILIP JAMES BRYAN MSW, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6783 S REDWOOD RD STE 103
WEST JORDAN UT
84084-5685
US

IV. Provider business mailing address

6783 S REDWOOD RD STE 103
WEST JORDAN UT
84084-5685
US

V. Phone/Fax

Practice location:
  • Phone: 801-613-9843
  • Fax:
Mailing address:
  • Phone: 801-613-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11640386-3506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: