Provider Demographics
NPI:1295895886
Name:BARRETT, BETH A (MFT)
Entity type:Individual
Prefix:MISS
First Name:BETH
Middle Name:A
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 WASATCH BLVD # ST320
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4709
Mailing Address - Country:US
Mailing Address - Phone:801-274-3500
Mailing Address - Fax:
Practice Address - Street 1:4505 WASATCH BLVD # ST320
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124-4709
Practice Address - Country:US
Practice Address - Phone:801-274-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116583-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist