Individual
BRIAN LAMAR PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3724 S 2000 E, SALT LAKE CITY, UT 84109-3318
(801) 272-5138
Mailing address
3724 S 2000 E, SALT LAKE CITY, UT 84109-3318
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
117747-3501
UT
Other
Enumeration date
04/09/2008
Last updated
04/09/2008
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