Provider Demographics
NPI:1053870220
Name:GUTER, BRAEDEN M
Entity type:Individual
Prefix:
First Name:BRAEDEN
Middle Name:M
Last Name:GUTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 S STATE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7144
Mailing Address - Country:US
Mailing Address - Phone:801-867-3472
Mailing Address - Fax:801-401-7850
Practice Address - Street 1:11650 S STATE ST STE 104
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7144
Practice Address - Country:US
Practice Address - Phone:801-867-3472
Practice Address - Fax:801-401-7850
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12467863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health