Provider Demographics
NPI:1669009205
Name:BROWN, CASSANDRA (MFT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1601 S 760 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5301
Mailing Address - Country:US
Mailing Address - Phone:801-400-2609
Mailing Address - Fax:
Practice Address - Street 1:3325 N UNIVERSITY AVE STE 275
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7415
Practice Address - Country:US
Practice Address - Phone:801-400-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8182432-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist