Healthcare Provider Details

I. General information

NPI: 1467268367
Provider Name (Legal Business Name): AMETHYST COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 E 4800 S STE 220
MURRAY UT
84107-5533
US

IV. Provider business mailing address

1341 E 4750 S APT F5
MILLCREEK UT
84117-8022
US

V. Phone/Fax

Practice location:
  • Phone: 801-928-3642
  • Fax:
Mailing address:
  • Phone: 801-928-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HAYLEY BURR
Title or Position: COUNSELOR
Credential: LCMHC
Phone: 801-928-3642