Healthcare Provider Details

I. General information

NPI: 1275230344
Provider Name (Legal Business Name): AUTHENTICALLY YOU MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 W BAILIFF DR
KEARNS UT
84118-7302
US

IV. Provider business mailing address

5506 W BAILIFF DR
KEARNS UT
84118-7302
US

V. Phone/Fax

Practice location:
  • Phone: 385-217-4087
  • Fax: 801-203-5160
Mailing address:
  • Phone: 385-217-4087
  • Fax: 801-203-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FAEIZA JAVED
Title or Position: SOLE MBR/OWNER/DIRECTOR
Credential: LCSW
Phone: 801-634-3782