Healthcare Provider Details

I. General information

NPI: 1770247298
Provider Name (Legal Business Name): TREVOR DANE GREGERSON CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S EAST REDVIEW DR
MONROE UT
84754-4633
US

IV. Provider business mailing address

840 S EAST REDVIEW DR
MONROE UT
84754-4633
US

V. Phone/Fax

Practice location:
  • Phone: 435-558-0611
  • Fax:
Mailing address:
  • Phone: 435-558-0611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.013648
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013648
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11353007-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: