Provider Demographics
NPI:1609637214
Name:BRIEM, MYKEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MYKEN
Middle Name:
Last Name:BRIEM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MYKEN
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 E 1300 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-1966
Mailing Address - Country:US
Mailing Address - Phone:801-921-3813
Mailing Address - Fax:
Practice Address - Street 1:559 E 1300 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-1966
Practice Address - Country:US
Practice Address - Phone:801-921-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT365887-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical