Provider Demographics
NPI:1407373426
Name:BRECK, BETHANY MARIE
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:BRECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3740 S MARKET CENTER DRIVE
Mailing Address - Street 2:#1200
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065
Mailing Address - Country:US
Mailing Address - Phone:801-240-9436
Mailing Address - Fax:
Practice Address - Street 1:3740 S MARKET CENTER DRIVE
Practice Address - Street 2:#1200
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-240-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor