Healthcare Provider Details

I. General information

NPI: 1760968192
Provider Name (Legal Business Name): ASHLEY CREER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 S 900 E
MURRAY UT
84121-1644
US

IV. Provider business mailing address

3982 S 2280 E
HOLLADAY UT
84124-1817
US

V. Phone/Fax

Practice location:
  • Phone: 801-738-7616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number107923236009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: