Basic Information
| Provider Information | |||||||||
| NPI: | 1124355789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 S 900 E STE 300 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841023064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015321850 | ||||||||
| FaxNumber: | 8015323608 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 S 900 E STE 300 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841023064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015321850 | ||||||||
| FaxNumber: | 8015323608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 11/03/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6380972-3502 | UT | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.