Healthcare Provider Details

I. General information

NPI: 1336059633
Provider Name (Legal Business Name): OME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7204 S STATION CREEK WAY APT 4L
COTTONWOOD HEIGHTS UT
84047-4225
US

IV. Provider business mailing address

7204 S STATION CREEK WAY APT 4L
COTTONWOOD HEIGHTS UT
84047-4225
US

V. Phone/Fax

Practice location:
  • Phone: 385-296-9799
  • Fax:
Mailing address:
  • Phone: 385-296-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: HAREF MONTALVO
Title or Position: OWNER
Credential: LCSW
Phone: 801-634-7454