Provider Demographics
NPI:1568960961
Name:MINGO, BROOK (CMHC)
Entity Type:Individual
Prefix:MRS
First Name:BROOK
Middle Name:
Last Name:MINGO
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 S SUNNYDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2046
Mailing Address - Country:US
Mailing Address - Phone:385-355-1295
Mailing Address - Fax:
Practice Address - Street 1:5784 S 900 E # 14
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1689
Practice Address - Country:US
Practice Address - Phone:385-355-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT94315756004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health