Provider Demographics
NPI:1669945531
Name:ALLEN, BRANDON LEE
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:LEE
Last Name:ALLEN
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 1:971 SOUTH 800 WEST
Mailing Address - Street 2:#104
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302
Mailing Address - Country:US
Mailing Address - Phone:435-239-8445
Mailing Address - Fax:
Practice Address - Street 1:971 SOUTH 800 WEST
Practice Address - Street 2:#104
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302
Practice Address - Country:US
Practice Address - Phone:435-239-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor