Provider Demographics
NPI:1649599051
Name:BRINKERHOFF, ARVEL JAMES (LSAC)
Entity Type:Individual
Prefix:
First Name:ARVEL
Middle Name:JAMES
Last Name:BRINKERHOFF
Suffix:
Gender:M
Credentials:LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 S 600 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1007
Mailing Address - Country:US
Mailing Address - Phone:801-428-3465
Mailing Address - Fax:801-359-3864
Practice Address - Street 1:68 S. 600 E.
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-428-3465
Practice Address - Fax:801-359-3864
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT313107-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTNPIMedicaid