Healthcare Provider Details

I. General information

NPI: 1346177888
Provider Name (Legal Business Name): AMANDA DOS SANTOS ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13751 S WADSWORTH PARK DR STE 103
DRAPER UT
84020-2103
US

IV. Provider business mailing address

3643 W SONNE LN UNIT W201
HERRIMAN UT
84096-2104
US

V. Phone/Fax

Practice location:
  • Phone: 801-978-3236
  • Fax:
Mailing address:
  • Phone: 801-503-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14118008-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: