Provider Demographics
NPI:1790030047
Name:BEALL, BRYAN THOMAS
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:THOMAS
Last Name:BEALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 W 1290 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2327
Mailing Address - Country:US
Mailing Address - Phone:801-664-6755
Mailing Address - Fax:602-735-3405
Practice Address - Street 1:32 W WINCHESTER ST STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5609
Practice Address - Country:US
Practice Address - Phone:801-263-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor