Healthcare Provider Details

I. General information

NPI: 1437469756
Provider Name (Legal Business Name): ASHLEY CHRISTINE BURKETT LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY CHRISTINE PRESCOTT LCMHC

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 S 8500 W
MAGNA UT
84044
US

IV. Provider business mailing address

PO BOX 330
MAGNA UT
84044-0330
US

V. Phone/Fax

Practice location:
  • Phone: 801-990-4300
  • Fax: 801-967-2127
Mailing address:
  • Phone: 801-990-4300
  • Fax: 801-967-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8739574-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0011485
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: