Healthcare Provider Details

I. General information

NPI: 1255192704
Provider Name (Legal Business Name): CONGRUITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7994 S PIONEER ST
MIDVALE UT
84047-7417
US

IV. Provider business mailing address

PO BOX 986
MIDVALE UT
84047-0982
US

V. Phone/Fax

Practice location:
  • Phone: 425-577-4855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY LOUISE SMITH
Title or Position: OWNER
Credential: CMHC
Phone: 801-413-3042