Healthcare Provider Details

I. General information

NPI: 1053237131
Provider Name (Legal Business Name): EMBER LYNN CROSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14551 SOUTH SENTINEL RIDGE BLVD
HERRIMAN UT
84096-1312
US

IV. Provider business mailing address

201 E RED PINE DR UNIT 15
ALPINE UT
84004-5619
US

V. Phone/Fax

Practice location:
  • Phone: 801-957-6625
  • Fax:
Mailing address:
  • Phone: 801-707-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101YA0400X
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: