Healthcare Provider Details

I. General information

NPI: 1326953563
Provider Name (Legal Business Name): KIMBERLY TERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E 1450 S STE 115
CLEARFIELD UT
84015-2282
US

IV. Provider business mailing address

36 TRAILSIDE RD
FARMINGTON UT
84025-5018
US

V. Phone/Fax

Practice location:
  • Phone: 801-252-5047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12900351-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: