Anthony Edlefsen

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11699198-6004 Issued in UT

Practice address

35 Skyline Dr
Brigham City, UT 84302-6772

Phone

(801) 255-5131

NPI assigned

Apr 10, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1912750688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6013 S REDWOOD RD",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841235220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 SKYLINE DR",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843026772",
            "telephone_number": "801-255-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDLEFSEN",
        "first_name": "ANTHONY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "11699198-6004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@utbs.co",
            "affiliation": "N",
            "address_1": "35 Skyline Dr",
            "city": "Brigham City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "843026772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Brigham City, UT
• Providers in Brigham City, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.