Provider Demographics
NPI:1912281585
Name:BROTHERSON, AMY ENGLE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ENGLE
Last Name:BROTHERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 W 300 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3525
Mailing Address - Country:US
Mailing Address - Phone:435-669-7109
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S STE 205
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5732
Practice Address - Country:US
Practice Address - Phone:435-669-7109
Practice Address - Fax:435-359-4150
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT7331860-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor