Provider Demographics
NPI:1023683380
Name:ALLRED, BRITTANY
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:ALLRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 189
Mailing Address - Street 2:64 W ROCKY RIDGE RD
Mailing Address - City:MONA
Mailing Address - State:UT
Mailing Address - Zip Code:84645
Mailing Address - Country:US
Mailing Address - Phone:208-569-7680
Mailing Address - Fax:
Practice Address - Street 1:64 W ROCKY RIDGE RD
Practice Address - Street 2:
Practice Address - City:MONA
Practice Address - State:UT
Practice Address - Zip Code:84645-7878
Practice Address - Country:US
Practice Address - Phone:208-569-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist