Healthcare Provider Details

I. General information

NPI: 1649933474
Provider Name (Legal Business Name): LORI STROUP CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 09/12/2024
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E DRAPERPARKWAY SUITE #103
DRAPER UT
84020
US

IV. Provider business mailing address

398 W CORNELL DR
MIDVALE UT
84047
US

V. Phone/Fax

Practice location:
  • Phone: 385-842-1539
  • Fax:
Mailing address:
  • Phone: 385-842-1539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10562677-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: