Provider Demographics
NPI:1407175151
Name:CRANE, BRENT E
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:E
Last Name:CRANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1548
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-9738
Mailing Address - Country:US
Mailing Address - Phone:435-722-5656
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 1548
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-9738
Practice Address - Country:US
Practice Address - Phone:435-722-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5206563-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist