Provider Demographics
NPI:1760015515
Name:GREEN, BRIANNA (CMHC, MT-BC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CMHC, MT-BC
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:ALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:270 S MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6249
Mailing Address - Country:US
Mailing Address - Phone:801-683-9340
Mailing Address - Fax:
Practice Address - Street 1:270 S MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6249
Practice Address - Country:US
Practice Address - Phone:801-683-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09729225A00000X
UT10529333-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist