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General NPI Number Information
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NPI Number | 1174741433
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Entity Type | Individual
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Provider Name | BRADLEY KENT GARVIN L.P.C
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 7487 S 95 E
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City | MIDVALE
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State | UT
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Zip | 84047-2150
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Country | US
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Telephone | 801-803-8517
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 183
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City | BOUNTIFUL
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State | UT
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Zip | 84011-0183
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Country | US
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Telephone | 801-803-8517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 140019-6004
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License Number State | UT
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