Healthcare Provider Details

I. General information

NPI: 1528188273
Provider Name (Legal Business Name): BRIAN D. BEUTLER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N 5TH ST W
RIVERTON WY
82501-3453
US

IV. Provider business mailing address

585 DINWOODY CIR
RIVERTON WY
82501-2210
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-9495
  • Fax:
Mailing address:
  • Phone: 307-709-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW-26872
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: