Provider Demographics
NPI:1669043840
Name:PLATT, K BRENT (LCSW)
Entity Type:Individual
Prefix:
First Name:K
Middle Name:BRENT
Last Name:PLATT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E 200 S
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2725
Mailing Address - Country:US
Mailing Address - Phone:801-368-5122
Mailing Address - Fax:
Practice Address - Street 1:135 W CENTER ST
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2207
Practice Address - Country:US
Practice Address - Phone:801-785-1169
Practice Address - Fax:801-785-1154
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT273899-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty