Provider Demographics
NPI:1962847624
Name:WATTERS, BRANT STEVEN (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANT
Middle Name:STEVEN
Last Name:WATTERS
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 1:5663 S REDWOOD RD STE OFFICE14
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5387
Mailing Address - Country:US
Mailing Address - Phone:801-893-7767
Mailing Address - Fax:801-709-1991
Practice Address - Street 1:5663 S REDWOOD RD STE OFFICE14
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5387
Practice Address - Country:US
Practice Address - Phone:801-893-7767
Practice Address - Fax:801-709-1991
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT8956144-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program