Healthcare Provider Details

I. General information

NPI: 1730033002
Provider Name (Legal Business Name): AMRA ROSE STARCHILD SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E STE 200255
MURRAY UT
84121-1757
US

IV. Provider business mailing address

5965 S 900 E STE 200255
MURRAY UT
84121-1757
US

V. Phone/Fax

Practice location:
  • Phone: 509-655-9843
  • Fax:
Mailing address:
  • Phone: 844-488-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14292521-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: