Healthcare Provider Details

I. General information

NPI: 1467826685
Provider Name (Legal Business Name): EMILY JEAN HACKETT CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2015
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N 1700 W
LAYTON UT
84041-8803
US

IV. Provider business mailing address

4536 BARCLAY DR
ATLANTA GA
30338-7145
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-4840
  • Fax: 801-525-8151
Mailing address:
  • Phone: 770-458-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11039527-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008224
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: