Individual
MR. BRYAN CALVIN HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4460 HIGHLAND DR STE 110, SALT LAKE CITY, UT 84124-3543
(801) 273-4090
Mailing address
4646 ATWOOD BLVD, MURRAY, UT 84107-3910
(801) 232-6636
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1790473501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17904735000001
BLUE CROSS PROVIDER #
UT
Enumeration date
02/01/2007
Last updated
07/08/2007
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