Healthcare Provider Details

I. General information

NPI: 1730950205
Provider Name (Legal Business Name): MARY GARRETT LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 N TRIUMPH BLVD STE 102
LEHI UT
84043-6132
US

IV. Provider business mailing address

11492 S 3420 W
SOUTH JORDAN UT
84095-8159
US

V. Phone/Fax

Practice location:
  • Phone: 801-435-1298
  • Fax:
Mailing address:
  • Phone: 360-951-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13746237-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: