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General NPI Number Information
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NPI Number | 1639032303
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Entity Type | Individual
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Provider Name | JUSTIN BRADLEY BRULLA CSW
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Gender | Male
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 245 HIGHWAY 198 STE 5
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City | SALEM
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State | UT
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Zip | 84653-5608
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Country | US
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Telephone | 385-208-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 245 HIGHWAY 198 STE 5
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City | SALEM
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State | UT
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Zip | 84653-5608
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Country | US
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Telephone | 385-208-7701
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 140726503502
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License Number State | UT
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