Healthcare Provider Details

I. General information

NPI: 1033849633
Provider Name (Legal Business Name): MERRITT GRACE LEBRECHT ACMHC, TRS, CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18406 W WHITE QUEST DR
EAGLE MOUNTAIN UT
84013-9701
US

IV. Provider business mailing address

13417 S AINTREE AVE
DRAPER UT
84020-8887
US

V. Phone/Fax

Practice location:
  • Phone: 801-335-4699
  • Fax: 801-335-7031
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12103709-6009
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number12103709-4002
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: