Provider Demographics
NPI:1265972285
Name:BLANCHARD, BRETT (LCMHC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 2100 S STE 244
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1980
Mailing Address - Country:US
Mailing Address - Phone:385-231-8387
Mailing Address - Fax:801-660-2474
Practice Address - Street 1:140 W 2100 S STE 244
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1980
Practice Address - Country:US
Practice Address - Phone:385-231-8387
Practice Address - Fax:801-660-2474
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8716801-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health