Provider Demographics
NPI:1588371223
Name:VITZTHUM, BRETT GAYLON (MS LMHC)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:GAYLON
Last Name:VITZTHUM
Suffix:
Gender:M
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COURT AVE STE 241
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2282
Mailing Address - Country:US
Mailing Address - Phone:515-901-2974
Mailing Address - Fax:515-875-4817
Practice Address - Street 1:309 COURT AVE STE 241
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2282
Practice Address - Country:US
Practice Address - Phone:515-901-2974
Practice Address - Fax:515-875-4817
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA105065OtherSTATE OF IOWA