Healthcare Provider Details

I. General information

NPI: 1093126187
Provider Name (Legal Business Name): SHAWNA KAY HENRY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12244 S BUSINESS PARK DR STE 245
DRAPER UT
84020-6532
US

IV. Provider business mailing address

12244 S BUSINESS PARK DR STE 245
DRAPER UT
84020-6532
US

V. Phone/Fax

Practice location:
  • Phone: 385-336-7879
  • Fax:
Mailing address:
  • Phone: 385-336-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8521808-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: