Provider Demographics
NPI:1174741433
Name:GARVIN, BRADLEY KENT (LPC)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:KENT
Last Name:GARVIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0183
Mailing Address - Country:US
Mailing Address - Phone:801-803-8517
Mailing Address - Fax:
Practice Address - Street 1:7487 S 95 E
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2150
Practice Address - Country:US
Practice Address - Phone:801-803-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140019-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional