Basic Information
Provider Information
NPI: 1003141326
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WESSON
FirstName: BRENDA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: CMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14 N MAIN ST
Address2:  
City: SPRINGVILLE
State: UT
PostalCode: 846631350
CountryCode: US
TelephoneNumber: 8013107478
FaxNumber:  
Practice Location
Address1: 14 N MAIN ST
Address2:  
City: SPRINGVILLE
State: UT
PostalCode: 846631350
CountryCode: US
TelephoneNumber: 8013107478
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/04/2009
LastUpdateDate: 11/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X1125766004UTY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


Home