Provider Demographics
NPI:1124452669
Name:DUSTIN, BRETT ADAM (CSW)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:ADAM
Last Name:DUSTIN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 S CARBON AVE
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-3226
Mailing Address - Country:US
Mailing Address - Phone:435-650-0315
Mailing Address - Fax:
Practice Address - Street 1:453 S CARBON AVE
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3226
Practice Address - Country:US
Practice Address - Phone:435-650-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-01
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9068999-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker