Healthcare Provider Details

I. General information

NPI: 1629551007
Provider Name (Legal Business Name): CHRISTYN GERBER ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N ASPEN RD
LOA UT
84747
US

IV. Provider business mailing address

520 N ASPEN RD
LOA UT
84747
US

V. Phone/Fax

Practice location:
  • Phone: 866-436-4458
  • Fax:
Mailing address:
  • Phone: 866-436-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11336680-6009
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: