Healthcare Provider Details

I. General information

NPI: 1013834563
Provider Name (Legal Business Name): KRISTY C ELLZEY ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 E PIONEER RD
DRAPER UT
84020-9300
US

IV. Provider business mailing address

13425 S SILVER ROCK LN
DRAPER UT
84020-7020
US

V. Phone/Fax

Practice location:
  • Phone: 801-598-5744
  • Fax:
Mailing address:
  • Phone: 801-598-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14289997-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: