Healthcare Provider Details

I. General information

NPI: 1598266553
Provider Name (Legal Business Name): ERICKA BRONTE ORTEGA CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 E 3100 N STE 2
LAYTON UT
84040-2408
US

IV. Provider business mailing address

1730 E 3100 N STE 2
LAYTON UT
84040-2408
US

V. Phone/Fax

Practice location:
  • Phone: 307-399-2896
  • Fax:
Mailing address:
  • Phone: 307-399-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12317217-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: