Active NPI
Brett Mortensen, CMHC
- Mental Health Counselor
- Provo, UT
National Provider Identifier
1053921536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6377316-6004
- Practice address
- 1300 E Center St
Provo, UT 84606-3554 - Phone
- (801) 344-4400
- Fax
- (801) 344-4225
- NPI assigned
- Aug 9, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6377316-6004 | UT | Primary |
Addresses
Primary practice location
1300 E Center St
Provo, UT 84606-3554
Mailing address
1300 E Center St
Provo, UT 84606-3554
Phone (801) 344-4400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6377316-6004 | UT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596931200000",
"number": "1053921536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 E CENTER ST",
"city": "PROVO",
"state": "UT",
"postal_code": "846063554",
"telephone_number": "801-344-4400",
"fax_number": "801-344-4225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 E CENTER ST",
"city": "PROVO",
"state": "UT",
"postal_code": "846063554",
"telephone_number": "801-344-4400",
"fax_number": "801-344-4225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTENSEN",
"first_name": "BRETT",
"credential": "CMHC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-09",
"last_updated": "2020-08-09",
"certification_date": "2020-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "6377316-6004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.