Healthcare Provider Details

I. General information

NPI: 1255286365
Provider Name (Legal Business Name): ERIK CHIAVOLA-LARSON ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 275
MURRAY UT
84107-8605
US

IV. Provider business mailing address

4516 S 700 E STE 275
MURRAY UT
84107-8605
US

V. Phone/Fax

Practice location:
  • Phone: 801-317-1950
  • Fax:
Mailing address:
  • Phone: 801-317-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14184764-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: