Healthcare Provider Details

I. General information

NPI: 1578494555
Provider Name (Legal Business Name): SOUTHERN MENTAL HEALTH THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 N 325 W
BOUNTIFUL UT
84010-6808
US

IV. Provider business mailing address

1557 W VIVANTE WAY
WEST VALLEY CITY UT
84119-8202
US

V. Phone/Fax

Practice location:
  • Phone: 315-597-0025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH SOUTHERN
Title or Position: DIRECTOR
Credential:
Phone: 315-597-0025