Healthcare Provider Details

I. General information

NPI: 1225765696
Provider Name (Legal Business Name): YOTAM LIVNAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 E 4680 S
MURRAY UT
84117-5035
US

IV. Provider business mailing address

817 E 4680 S APT B121
MURRAY UT
84117-1614
US

V. Phone/Fax

Practice location:
  • Phone: 385-370-9854
  • Fax:
Mailing address:
  • Phone: 385-370-9854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11789976-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: