Provider Demographics
NPI:1063871515
Name:ALLISON, MICHAEL BRYAN (LMFT, ABS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRYAN
Last Name:ALLISON
Suffix:
Gender:M
Credentials:LMFT, ABS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 S 2200 E
Mailing Address - Street 2:
Mailing Address - City:UINTAH
Mailing Address - State:UT
Mailing Address - Zip Code:84405-9708
Mailing Address - Country:US
Mailing Address - Phone:801-644-9626
Mailing Address - Fax:801-210-5383
Practice Address - Street 1:6610 S 2200 E
Practice Address - Street 2:
Practice Address - City:UINTAH
Practice Address - State:UT
Practice Address - Zip Code:84405-9708
Practice Address - Country:US
Practice Address - Phone:801-644-9626
Practice Address - Fax:801-210-5383
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8906663-3902101YM0800X, 102L00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst