Healthcare Provider Details

I. General information

NPI: 1316792088
Provider Name (Legal Business Name): TAYA PEARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 W EXECUTIVE PKWY STE 272
LEHI UT
84048-9642
US

IV. Provider business mailing address

2975 W EXECUTIVE PKWY STE 272
LEHI UT
84048-9642
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-7732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14286237-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: