Healthcare Provider Details

I. General information

NPI: 1295025575
Provider Name (Legal Business Name): MARY CHRISTENA ATTRIDGE CMHC, ATR-BC, ATCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 06/11/2019
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

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

V. Phone/Fax

Practice location:
  • Phone: 801-305-3171
  • Fax: 801-904-3632
Mailing address:
  • Phone: 801-305-3171
  • Fax: 801-904-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number06-009
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9022525-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: