Provider Demographics
NPI:1538331913
Name:CHERRY, BRIAN (CMHC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CHERRY
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 S VILLAGE RIVER LN
Mailing Address - Street 2:#3
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5641
Mailing Address - Country:US
Mailing Address - Phone:801-671-2876
Mailing Address - Fax:
Practice Address - Street 1:5689 S REDWOOD RD
Practice Address - Street 2:SUITE 27
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5447
Practice Address - Country:US
Practice Address - Phone:801-266-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT68365696009101Y00000X
UT68365696004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538331913OtherNPI NUMBER