Provider Demographics
NPI:1457930109
Name:ANDERSON, BREE
Entity type:Individual
Prefix:
First Name:BREE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1359
Mailing Address - Country:US
Mailing Address - Phone:801-272-9980
Mailing Address - Fax:801-272-9976
Practice Address - Street 1:5800 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1359
Practice Address - Country:US
Practice Address - Phone:801-272-9980
Practice Address - Fax:801-272-9976
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12506648-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty