Provider Demographics
NPI:1588796858
Name:WILLIAMS, BRETT RICHARD (MFT)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:RICHARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-465-4896
Mailing Address - Fax:801-465-4107
Practice Address - Street 1:97 PROFESSIONAL WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1614
Practice Address - Country:US
Practice Address - Phone:801-465-4896
Practice Address - Fax:801-465-4107
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7798727-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist