Healthcare Provider Details

I. General information

NPI: 1588067516
Provider Name (Legal Business Name): HILLARY ROSE CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2014
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7070 S UNION PARK AVE STE 150
MIDVALE UT
84047-6043
US

IV. Provider business mailing address

1421 W 500 N
SALT LAKE CITY UT
84116-2549
US

V. Phone/Fax

Practice location:
  • Phone: 801-405-7450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9855528-6004
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: