MEDICARE: MYKEN BRIEM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	365887-3501	UT

General Provider Information

NPI Number	:	1609637214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYKEN BRIEM LCSW

Provider Business Mailing Address
First Line	:	559 E 1300 N
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-1966
Country	:	US
Telephone Number	:	801-921-3813
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 E 1300 N
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-1966
Country	:	US
Telephone Number	:	801-921-3813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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Directions to “ MYKEN BRIEM LCSW” Practice Location

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