Healthcare Provider Details

I. General information

NPI: 1063686160
Provider Name (Legal Business Name): WAYNE SEARS CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E BAMBERGER DR STE D
AMERICAN FORK UT
84003-2179
US

IV. Provider business mailing address

7657 N WILLOW WALK LN
EAGLE MOUNTAIN UT
84005-5885
US

V. Phone/Fax

Practice location:
  • Phone: 801-633-7677
  • Fax:
Mailing address:
  • Phone: 801-633-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number284138-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number284138-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: