Healthcare Provider Details

I. General information

NPI: 1790131795
Provider Name (Legal Business Name): ANNE FELT SMITH CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 S 900 E STE 105
MIDVALE UT
84047-1710
US

IV. Provider business mailing address

1924 E SIGGARD DR
SALT LAKE CITY UT
84106-3838
US

V. Phone/Fax

Practice location:
  • Phone: 801-305-3171
  • Fax:
Mailing address:
  • Phone: 801-244-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10378587-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: