Provider Demographics
NPI:1881453488
Name:MITCHELL, BRIAN PAUL (PMHNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 E THREE FOUNTAINS CIR UNIT 47
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5249
Mailing Address - Country:US
Mailing Address - Phone:801-970-2676
Mailing Address - Fax:
Practice Address - Street 1:476 HERITAGE PK BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5636
Practice Address - Country:US
Practice Address - Phone:801-896-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11817116-44052084P0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry