Provider Demographics
NPI:1528188273
Name:BEUTLER, BRIAN D (LMSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:BEUTLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 DINWOODY CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2210
Mailing Address - Country:US
Mailing Address - Phone:307-709-1776
Mailing Address - Fax:
Practice Address - Street 1:121 N 5TH ST W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3453
Practice Address - Country:US
Practice Address - Phone:307-856-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLMSW-26872101Y00000X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor