Provider Demographics
NPI:1043970262
Name:SMILE PSYCHIATRY AND BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SMILE PSYCHIATRY AND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-406-6256
Mailing Address - Street 1:138 E 12300 S UNIT 328
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7976
Mailing Address - Country:US
Mailing Address - Phone:801-406-6256
Mailing Address - Fax:859-545-4978
Practice Address - Street 1:138 E 12300 S UNIT 328
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7976
Practice Address - Country:US
Practice Address - Phone:801-406-6256
Practice Address - Fax:859-545-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty