Basic Information
| Provider Information | |||||||||
| NPI: | 1477784650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ALEC | ||||||||
| MiddleName: | JUDD | ||||||||
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| Credential: | ED.S., M.S., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 N 1650 E | ||||||||
| Address2: | |||||||||
| City: | LEHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840434782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014737409 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9361 S 300 E | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840702902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018265000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2009 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | 4014728 | AZ | N | Behavioral Health & Social Service Providers | Psychologist | School | 103TS0200X | 8483321-2501 | UT | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.