Healthcare Provider Details

I. General information

NPI: 1083030969
Provider Name (Legal Business Name): SUMMER LYNN WOOLSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMMER LYNN JOHNSON MA, LAMFT

II. Dates (important events)

Enumeration Date: 03/15/2014
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W 600 N
KOOSHAREM UT
84744-7745
US

IV. Provider business mailing address

PO BOX 440013
KOOSHAREM UT
84744-0013
US

V. Phone/Fax

Practice location:
  • Phone: 801-793-0388
  • Fax:
Mailing address:
  • Phone: 801-793-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8777194-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: