Provider Demographics
NPI:1407256753
Name:REASE, BRANDON KEENAN
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:KEENAN
Last Name:REASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 W 1850 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-7818
Mailing Address - Country:US
Mailing Address - Phone:801-425-3440
Mailing Address - Fax:
Practice Address - Street 1:78 W 1850 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7818
Practice Address - Country:US
Practice Address - Phone:801-425-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor