Provider Demographics
NPI:1619788015
Name:NUTT, BROOKE (CMHC INTERN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:NUTT
Suffix:
Gender:F
Credentials:CMHC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 S MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2136
Mailing Address - Country:US
Mailing Address - Phone:435-255-6150
Mailing Address - Fax:435-938-7151
Practice Address - Street 1:60 S MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2136
Practice Address - Country:US
Practice Address - Phone:435-255-6150
Practice Address - Fax:435-938-7151
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program