Healthcare Provider Details

I. General information

NPI: 1326759564
Provider Name (Legal Business Name): LAUREN JOHNSON ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 S STATE ST STE 104
DRAPER UT
84020-7144
US

IV. Provider business mailing address

11650 S STATE ST STE 104
DRAPER UT
84020-7144
US

V. Phone/Fax

Practice location:
  • Phone: 801-867-3472
  • Fax: 801-306-6353
Mailing address:
  • Phone: 801-867-3472
  • Fax: 801-306-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14290164-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: