Provider Demographics
NPI:1912736257
Name:MAGEE, BRAYDEN THOMAS
Entity type:Individual
Prefix:
First Name:BRAYDEN
Middle Name:THOMAS
Last Name:MAGEE
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 1:1100 S 2000 E APT M2005
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6218
Mailing Address - Country:US
Mailing Address - Phone:385-552-9099
Mailing Address - Fax:
Practice Address - Street 1:1100 S 2000 E APT M2005
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-6218
Practice Address - Country:US
Practice Address - Phone:385-552-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT233969039106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician