Provider Demographics
NPI:1134107881
Name:HALLETT, CHRISTOPHER BRENDAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BRENDAN
Last Name:HALLETT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BRENDAN
Other - Middle Name:
Other - Last Name:HALLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:537 DARWIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1733
Mailing Address - Country:US
Mailing Address - Phone:801-916-2831
Mailing Address - Fax:801-263-7279
Practice Address - Street 1:5965 S 900 E
Practice Address - Street 2:VALLEY MENTAL HEALTH A&D SUITE 240
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1720
Practice Address - Country:US
Practice Address - Phone:801-263-7225
Practice Address - Fax:801-263-7279
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4912036-2501103TA0400X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107015235101OtherINTERMOUNTAIN HEALTH CARE
UT780734OtherDESERET MUTUAL
UTQ11745Medicare ID - Type UnspecifiedMEDICARE ADVANTAGE PLANS