Healthcare Provider Details

I. General information

NPI: 1033936448
Provider Name (Legal Business Name): CHRISTIAN OWNSBEY MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 S UNION PARK CTR STE 614
MIDVALE UT
84047-6501
US

IV. Provider business mailing address

6975 S UNION PARK CTR STE 614
MIDVALE UT
84047-6501
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-9277
  • Fax:
Mailing address:
  • Phone: 801-747-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14086713-6006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: