Provider Demographics
NPI:1265962435
Name:SKILES, BRYAN EUGENE (CMHC, LMHC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:EUGENE
Last Name:SKILES
Suffix:
Gender:M
Credentials:CMHC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E WILLOW HAVEN CV
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8905
Mailing Address - Country:US
Mailing Address - Phone:425-260-6773
Mailing Address - Fax:
Practice Address - Street 1:1258 W SOUTH JORDAN PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4712
Practice Address - Country:US
Practice Address - Phone:385-446-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60918637101YM0800X
UT129753256004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health