Healthcare Provider Details

I. General information

NPI: 1346001195
Provider Name (Legal Business Name): KATIE LANDGREN ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 N MAIN ST STE 1
BOUNTIFUL UT
84010-5982
US

IV. Provider business mailing address

1335 N 640 W
WEST BOUNTIFUL UT
84087-1251
US

V. Phone/Fax

Practice location:
  • Phone: 385-424-0712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14201974-6009
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: