Provider Demographics
NPI:1154618973
Name:KAY, BRIAN GRANT (LCSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:GRANT
Last Name:KAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 W BULLDOG BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3334
Mailing Address - Country:US
Mailing Address - Phone:801-357-2567
Mailing Address - Fax:
Practice Address - Street 1:194 MISSILE AVE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58705
Practice Address - Country:US
Practice Address - Phone:701-723-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6900083-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical