Provider Demographics
NPI:1285864538
Name:ELGIE, BRIGETTE DENELL (MFT)
Entity Type:Individual
Prefix:MRS
First Name:BRIGETTE
Middle Name:DENELL
Last Name:ELGIE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683480
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-3480
Mailing Address - Country:US
Mailing Address - Phone:949-648-7004
Mailing Address - Fax:
Practice Address - Street 1:1283 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-5182
Practice Address - Country:US
Practice Address - Phone:949-648-7004
Practice Address - Fax:435-649-2268
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43952106H00000X
UT9463019-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist