Healthcare Provider Details

I. General information

NPI: 1689501041
Provider Name (Legal Business Name): MCKENZIE ELISE HAMLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

382 W MAIN ST
DUCHESNE UT
84021-7761
US

IV. Provider business mailing address

250 E WILSON AVE
SALT LAKE CITY UT
84115-1936
US

V. Phone/Fax

Practice location:
  • Phone: 877-701-7600
  • Fax:
Mailing address:
  • Phone: 801-386-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number142441336009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: