Provider Demographics
NPI:1932920899
Name:BRUUN, DALLIN (MFT)
Entity type:Individual
Prefix:
First Name:DALLIN
Middle Name:
Last Name:BRUUN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 N 290 W
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1810
Mailing Address - Country:US
Mailing Address - Phone:855-229-2336
Mailing Address - Fax:
Practice Address - Street 1:199 N 290 W
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1810
Practice Address - Country:US
Practice Address - Phone:855-229-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14060951-3904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health