Provider Demographics
NPI:1326669219
Name:BRASSFIELD, HOLLY (LCSW RPT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BRASSFIELD
Suffix:
Gender:F
Credentials:LCSW RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2403
Mailing Address - Country:US
Mailing Address - Phone:801-980-1013
Mailing Address - Fax:
Practice Address - Street 1:233 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2403
Practice Address - Country:US
Practice Address - Phone:801-980-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11672516-35011041C0700X
UT11672516-35021041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator