Provider Demographics
NPI:1841987336
Name:SHULTS, BRYNLEE ANN
Entity type:Individual
Prefix:
First Name:BRYNLEE
Middle Name:ANN
Last Name:SHULTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 W 1275 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-2251
Mailing Address - Country:US
Mailing Address - Phone:435-592-4932
Mailing Address - Fax:
Practice Address - Street 1:104 W MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-3190
Practice Address - Country:US
Practice Address - Phone:180-195-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health