Provider Demographics
NPI:1285618561
Name:VETTER, BERNARD GEORGE (MSW DCSW BCD LCSW)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:GEORGE
Last Name:VETTER
Suffix:
Gender:M
Credentials:MSW DCSW BCD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037
Mailing Address - Country:US
Mailing Address - Phone:801-309-1079
Mailing Address - Fax:
Practice Address - Street 1:206 E MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2805
Practice Address - Country:US
Practice Address - Phone:801-309-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12985435011041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist