Healthcare Provider Details

I. General information

NPI: 1003031428
Provider Name (Legal Business Name): TAMARA OKELBERRY M.ED, CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 S 8800 W
MAGNA UT
84044-1238
US

IV. Provider business mailing address

2613 S 8800 W
MAGNA UT
84044-1238
US

V. Phone/Fax

Practice location:
  • Phone: 801-228-8966
  • Fax:
Mailing address:
  • Phone: 801-228-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCPC-3657
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number140534-6004
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW24292
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number140534-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: