Provider Demographics
NPI:1225347610
Name:HILDT, BRADY (PSYD)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:HILDT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 HIGHWAY 150 S STE F
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5361
Mailing Address - Country:US
Mailing Address - Phone:801-663-2415
Mailing Address - Fax:
Practice Address - Street 1:1565 HIGHWAY 150 S STE F
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5361
Practice Address - Country:US
Practice Address - Phone:801-663-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WY632103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health