Provider Demographics
NPI:1467708917
Name:HENLINE, BRANDEN HAYES (PHD, LMFT, CFLE)
Entity Type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:HAYES
Last Name:HENLINE
Suffix:
Gender:M
Credentials:PHD, LMFT, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 W VALLEY VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2667
Mailing Address - Country:US
Mailing Address - Phone:928-830-8501
Mailing Address - Fax:
Practice Address - Street 1:13552 S 110 W STE 204
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2403
Practice Address - Country:US
Practice Address - Phone:928-830-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15128106H00000X
UT9287734-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist