Provider Demographics
NPI:1780993741
Name:MIDDLEBROOK, DEBORAH ROSE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ROSE
Last Name:MIDDLEBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ROSE
Other - Last Name:ALVORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5934 S 4800 W
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-6061
Mailing Address - Country:US
Mailing Address - Phone:801-967-6325
Mailing Address - Fax:
Practice Address - Street 1:5934 S 4800 W
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-6061
Practice Address - Country:US
Practice Address - Phone:801-967-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor