Provider Demographics
NPI:1043734577
Name:PHILLIPS, DANIEL BARRATT (LCMHC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BARRATT
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:BARRATT
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC
Mailing Address - Street 1:3793 N PATIOSPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84310-9741
Mailing Address - Country:US
Mailing Address - Phone:801-458-7159
Mailing Address - Fax:
Practice Address - Street 1:3625 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2061
Practice Address - Country:US
Practice Address - Phone:801-458-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6895880-6004101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6895880-6004OtherDOPL