Healthcare Provider Details

I. General information

NPI: 1245971860
Provider Name (Legal Business Name): REBECCA MADSEN LCSW, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S 690 E
HYRUM UT
84319-1788
US

IV. Provider business mailing address

571 S 690 E
HYRUM UT
84319-1788
US

V. Phone/Fax

Practice location:
  • Phone: 801-210-1819
  • Fax:
Mailing address:
  • Phone: 801-210-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5034037-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: